Ayalon-Dangur Irit, Robenshtok Eyal, Duskin-Bitan Hadar, Tsvetov Gloria, Gorshtein Alex, Akirov Amit, Shimon Ilan
Division of Endocrinology and Metabolism, Rabin Medical Center, Affiliated to Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Clin Endocrinol (Oxf). 2023 Apr;98(4):559-566. doi: 10.1111/cen.14877. Epub 2023 Jan 11.
The treatment strategy for nonfunctioning pituitary adenomas (NFPA) includes surgery, radiotherapy, medical treatment, or follow-up. Prior series of patients with NFPAs followed without intervention include small numbers of patients with macroadenomas. This study investigated the natural history of patients with macroadenomas followed without treatment.
Retrospective cohort study included patients>18 years, with a diagnosis of NFPA ≥ 10 mm who were naïve to surgery or medical treatment and followed more than 12 months after diagnosis. Patients with chiasmal threat were excluded. Follow-up terminated if the patient underwent surgery, received cabergoline or was lost to follow-up.
Data collected included evaluation of tumour characteristics and size by MRI, symptoms including visual disturbances, and hormonal levels. Tumour growth was defined as maximal diameter increase of ≥2 mm.
The cohort included 49 patients (30 males, mean age 68.0 ± 12.0 years). At diagnosis, the average tumour size was 17.8 ± 5.9 mm. Mean follow-up time was 4.9 ± 4.9 years. Increase in tumour size occurred in 16 patients (33%), with an average growth of 5.1 ± 4.4 mm. Reduction in tumour size occurred in 10 patients (20%), with a mean decrease of 3.5 ± 1.3 mm. Twenty-three patients remained with stable tumours. Overall, 33 patients (67%) were observed without any intervention; 3 patients were operated and 13 were treated with cabergoline. None of the parameters including age, gender, baseline tumour size, invasiveness, visual disturbances, or hypopituitarism at diagnosis, predicted tumour growth.
Observation of NFPAs without surgery or medical therapy is a reasonable approach in selected patients. In our study, no parameter predicted tumour growth.
无功能垂体腺瘤（NFPA）的治疗策略包括手术、放疗、药物治疗或随访观察。既往未经干预随访观察的NFPA患者系列研究纳入的大腺瘤患者数量较少。本研究调查了未经治疗的大腺瘤患者的自然病程。
回顾性队列研究纳入年龄>18岁、诊断为NFPA且腺瘤直径≥10 mm、未接受过手术或药物治疗且诊断后随访超过12个月的患者。有视交叉受压风险的患者被排除。如果患者接受手术、服用卡麦角林或失访，则随访终止。
收集的数据包括通过MRI评估肿瘤特征和大小、包括视力障碍在内的症状以及激素水平。肿瘤生长定义为最大直径增加≥2 mm。
该队列包括49例患者（30例男性，平均年龄68.0±12.0岁）。诊断时，平均肿瘤大小为17.8±5.9 mm。平均随访时间为4.9±4.9年。16例患者（33%）肿瘤大小增加，平均增长5.1±4.4 mm。10例患者（20%）肿瘤大小减小，平均减小3.5±1.3 mm。23例患者肿瘤大小保持稳定。总体而言，33例患者（67%）未经任何干预进行观察；3例患者接受手术，13例患者接受卡麦角林治疗。包括年龄、性别、基线肿瘤大小、侵袭性、诊断时的视力障碍或垂体功能减退等参数，均不能预测肿瘤生长。
对于部分患者，不进行手术或药物治疗而观察NFPA是一种合理的方法。在我们的研究中，没有参数能够预测肿瘤生长。
