Tritos Nicholas A, Miller Karen K
Neuroendocrine Unit, Massachusetts General Hospital, Boston.
Harvard Medical School, Boston, Massachusetts.
JAMA. 2023 Apr 25;329(16):1386-1398. doi: 10.1001/jama.2023.5444.
Pituitary adenomas are neoplasms of the pituitary adenohypophyseal cell lineage and include functioning tumors, characterized by the secretion of pituitary hormones, and nonfunctioning tumors. Clinically evident pituitary adenomas occur in approximately 1 in 1100 persons.
Pituitary adenomas are classified as either macroadenomas (≥10 mm) (48% of tumors) or microadenomas (<10 mm). Macroadenomas may cause mass effect, such as visual field defects, headache, and/or hypopituitarism, which occur in about 18% to 78%, 17% to 75%, and 34% to 89% of patients, respectively. Thirty percent of pituitary adenomas are nonfunctioning adenomas, which do not produce hormones. Functioning tumors are those that produce an excess of normally produced hormones and include prolactinomas, somatotropinomas, corticotropinomas, and thyrotropinomas, which produce prolactin, growth hormone, corticotropin, and thyrotropin, respectively. Approximately 53% of pituitary adenomas are prolactinomas, which can cause hypogonadism, infertility, and/or galactorrhea. Twelve percent are somatotropinomas, which cause acromegaly in adults and gigantism in children, and 4% are corticotropinomas, which secrete corticotropin autonomously, resulting in hypercortisolemia and Cushing disease. All patients with pituitary tumors require endocrine evaluation for hormone hypersecretion. Patients with macroadenomas additionally require evaluation for hypopituitarism, and patients with tumors compressing the optic chiasm should be referred to an ophthalmologist for formal visual field testing. For those requiring treatment, first-line therapy is usually transsphenoidal pituitary surgery, except for prolactinomas, for which medical therapy, either bromocriptine or cabergoline, is usually first line.
Clinically manifest pituitary adenomas affect approximately 1 in 1100 people and can be complicated by syndromes of hormone excess as well as visual field defects and hypopituitarism from mass effect in larger tumors. First-line therapy for prolactinomas consists of bromocriptine or cabergoline, and transsphenoidal pituitary surgery is first-line therapy for other pituitary adenomas requiring treatment.
垂体腺瘤是垂体腺垂体细胞谱系的肿瘤，包括功能性肿瘤（其特征为分泌垂体激素）和无功能性肿瘤。临床上明显的垂体腺瘤在大约每1100人中就有1例发生。
垂体腺瘤分为大腺瘤（≥10毫米）（占肿瘤的48%）或微腺瘤（<10毫米）。大腺瘤可能会引起占位效应，如视野缺损、头痛和/或垂体功能减退，分别发生在约18%至78%、17%至75%和34%至89%的患者中。30%的垂体腺瘤是无功能性腺瘤，不产生激素。功能性肿瘤是那些产生过量正常分泌激素的肿瘤，包括催乳素瘤、生长激素瘤、促肾上腺皮质激素瘤和促甲状腺激素瘤，它们分别产生催乳素、生长激素、促肾上腺皮质激素和促甲状腺激素。大约53%的垂体腺瘤是催乳素瘤，可导致性腺功能减退、不孕和/或溢乳。12%是生长激素瘤，在成人中导致肢端肥大症，在儿童中导致巨人症，4%是促肾上腺皮质激素瘤，自主分泌促肾上腺皮质激素，导致皮质醇增多症和库欣病。所有垂体肿瘤患者都需要进行内分泌评估以检测激素分泌过多情况。大腺瘤患者还需要评估垂体功能减退情况，而肿瘤压迫视交叉的患者应转诊至眼科医生处进行正式的视野测试。对于那些需要治疗的患者，除催乳素瘤外，一线治疗通常是经蝶窦垂体手术，催乳素瘤的一线治疗通常是药物治疗，即溴隐亭或卡麦角林。
临床上明显的垂体腺瘤影响约每1100人中的1人，可能并发激素分泌过多综合征以及大肿瘤占位效应导致的视野缺损和垂体功能减退。催乳素瘤的一线治疗包括溴隐亭或卡麦角林，经蝶窦垂体手术是其他需要治疗的垂体腺瘤的一线治疗方法。
