Centre for Endocrinology, William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Alder Hey Children's Hospital, Liverpool, UK.
Nat Rev Endocrinol. 2024 May;20(5):278-289. doi: 10.1038/s41574-023-00948-8. Epub 2024 Feb 9.
Tumours of the anterior part of the pituitary gland represent just 1% of all childhood (aged <15 years) intracranial neoplasms, yet they can confer high morbidity and little evidence and guidance is in place for their management. Between 2014 and 2022, a multidisciplinary expert group systematically developed the first comprehensive clinical practice consensus guideline for children and young people under the age 19 years (hereafter referred to as CYP) presenting with a suspected pituitary adenoma to inform specialist care and improve health outcomes. Through robust literature searches and a Delphi consensus exercise with an international Delphi consensus panel of experts, the available scientific evidence and expert opinions were consolidated into 74 recommendations. Part 1 of this consensus guideline includes 17 pragmatic management recommendations related to clinical care, neuroimaging, visual assessment, histopathology, genetics, pituitary surgery and radiotherapy. While in many aspects the care for CYP is similar to that of adults, key differences exist, particularly in aetiology and presentation. CYP with suspected pituitary adenomas require careful clinical examination, appropriate hormonal work-up, dedicated pituitary imaging and visual assessment. Consideration should be given to the potential for syndromic disease and genetic assessment. Multidisciplinary discussion at both the local and national levels can be key for management. Surgery should be performed in specialist centres. The collection of outcome data on novel modalities of medical treatment, surgical intervention and radiotherapy is essential for optimal future treatment.
垂体前叶肿瘤占所有儿童（<15 岁）颅内肿瘤的 1%，但它们可导致高发病率，且目前针对其治疗的证据和指导很少。2014 年至 2022 年间，一个多学科专家小组系统地为 19 岁以下（以下简称 CYP）疑似垂体腺瘤的儿童和年轻人制定了首个全面的临床实践共识指南，以提供专业护理并改善健康结果。通过强有力的文献检索和国际专家德尔菲共识小组的德尔菲共识实践，将现有的科学证据和专家意见整合为 74 条建议。本共识指南的第 1 部分包括 17 条与临床护理、神经影像学、视觉评估、组织病理学、遗传学、垂体手术和放射治疗相关的实用管理建议。虽然 CYP 的护理在许多方面与成人相似，但存在关键差异，特别是在病因和表现方面。疑似垂体腺瘤的 CYP 需要仔细的临床检查、适当的激素检查、专门的垂体成像和视觉评估。应考虑潜在的综合征疾病和遗传评估。在地方和国家各级进行多学科讨论对于管理至关重要。手术应在专业中心进行。收集新型药物治疗、手术干预和放射治疗的结果数据对于未来的最佳治疗至关重要。
