Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, United States.
Front Endocrinol (Lausanne). 2022 Dec 13;13:1064216. doi: 10.3389/fendo.2022.1064216. eCollection 2022.
Pituitary adenomas (PAs) have been shown to cause excess cardiovascular disease comorbidity and mortality. Cerebrovascular disease (CeVD) is a small subset of cardiovascular disease with high morbidity, and its risk in patients with pituitary adenomas has been sparingly explored. In this review, we examine what is known about the prevalence of cerebrovascular disease in patients with PAs, from its initial discovery in 1970 to present. An abundance of literature describes increased cerebrovascular mortality in patients with acromegaly, while research on other PA subtypes is less frequent but shows a similarly elevated CeVD mortality relative to healthy populations. We also review how cerebrovascular risk changes after PAs are treated, with PA treatment appearing to prevent further accumulation of cerebrovascular risk without reversing prior elevations. While acromegaly-associated CeVD appears to be caused by elevated growth hormone (GH) levels and Cushing disease's elevated glucocorticoids similarly cause durable alterations in cerebrovascular structure and function, less is known about the mechanisms behind CeVD in other PA subpopulations. Proposed pathophysiologies include growth hormone deficiency inducing vessel wall damage or other hormone deficits causing increased atherosclerotic disease. Early diagnosis and treatment of PAs may be the key to minimizing lifetime CeVD risk elevations. More research is needed to better understand the mechanisms behind the increased CeVD seen in patients with PAs. Physicians caring for PA patients must remain vigilant for signs and symptoms of cerebrovascular disease in this patient population.
垂体腺瘤 (PAs) 已被证明会导致心血管疾病的发病率和死亡率增加。脑血管疾病 (CeVD) 是心血管疾病的一小部分，发病率高，其在垂体腺瘤患者中的风险很少被探索。在这篇综述中，我们检查了从 1970 年首次发现到现在，已知的垂体腺瘤患者脑血管疾病的患病率。大量文献描述了肢端肥大症患者的脑血管死亡率增加，而其他 PA 亚型的研究则较少，但与健康人群相比，CeVD 的死亡率也同样升高。我们还回顾了 PA 治疗后脑血管风险的变化，PA 治疗似乎可以防止脑血管风险的进一步积累，而不会逆转先前的升高。虽然与肢端肥大症相关的 CeVD 似乎是由生长激素 (GH) 水平升高引起的，而库欣病升高的糖皮质激素也会导致脑血管结构和功能的持久改变，但对于其他 PA 亚群中 CeVD 的发病机制知之甚少。提出的病理生理学机制包括生长激素缺乏导致血管壁损伤，或其他激素缺乏导致动脉粥样硬化疾病增加。早期诊断和治疗 PA 可能是降低终生 CeVD 风险升高的关键。需要更多的研究来更好地了解 PA 患者中观察到的 CeVD 增加的机制。治疗 PA 患者的医生必须对该患者群体中脑血管疾病的迹象和症状保持警惕。
