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一项关于无功能垂体意外瘤的真实世界纵向研究:PRECES微腺瘤亚分析

A Real-World Longitudinal Study in Non-Functioning Pituitary Incidentalomas: A PRECES Micro-Adenomas Sub-Analysis.

作者信息

Costachescu Mihai, Nistor Claudiu, Valea Ana, Sima Oana-Claudia, Ciuche Adrian, Stanciu Mihaela, Carsote Mara, Ciobica Mihai-Lucian

机构信息

Department of Radiology and Medical Imaging, Fundeni Clinical Institute, 022328 Bucharest, Romania.

PhD Doctoral School, "Carol Davila" University of Medicine and Pharmacy, 010825 Bucharest, Romania.

出版信息

Diseases. 2024 Oct 2;12(10):240. doi: 10.3390/diseases12100240.

Abstract

Incidentalomas have an increasing incidence all over the world due to a larger access to imaging assessments, and endocrine incidentalomas make no exception in this matter, including pituitary incidentalomas (PIs). Our objective was to analyse the dynamic changes amid a second computed tomography (CT) scan after adult patients were initially confirmed with a PI (non-functioning micro-adenoma). This was a multi-centric, longitudinal, retrospective study in adults (aged between 20 and 70 y) amid real-world data collection. We excluded patients who experienced baseline pituitary hormonal excess or deficiency or those with tumours larger than 1 cm. A total of 117 adults were included (94.02% females) with a mean age of 43.86 ± 11.99 years, followed between 6 and 156 months with a median (M) of 40 months (Q1 Q3: 13.50, 72.00). At the time of PI diagnosis, the transverse diameter had a mean value of 0.53 ± 0.16 cm, the longitudinal mean diameter was 0.41 ± 0.13 cm, and the largest diameter was 0.55 ± 0.16 cm. No PI became functioning during follow-up, neither associated hypopituitarism nor increased >1 cm diameter. A total of 46/117 (39.32%) patients had a larger diameter during follow-up (increase group = IG) versus a non-increase group (non-IG; N = 71, 60.68%) that included the subjects with stationary or decreased diameters. IG had lower initial transverse, longitudinal, and largest diameter versus non-IG: 0.45 ± 0.12 versus 0.57 ± 0.17 ( < 0.0001), 0.36 ± 0.11 versus 0.43 ± 0.13 ( = 0.004), respectively, 0.46 ± 0.12 versus 0.6 ± 0.16 ( < 0.0001). IG versus non-IG had a larger period of surveillance: M (Q1, Q3) of 48 (24, 84) versus 32.5 (12, 72) months ( = 0.045) and showed similar age, pituitary hormone profile, and tumour lateralisation at baseline and displayed a median diameter change of +0.14 cm versus -0.03 cm ( < 0.0001). , a rather high percent of patients might experience PI diameter increase during a longer period of follow-up, including those with a smaller initial size, while the age at diagnosis does not predict the tumour growth. This might help practitioners with further long-term surveillance protocols.

摘要

由于影像学检查的可及性提高,偶发瘤在全球的发病率不断上升,内分泌偶发瘤也不例外,包括垂体偶发瘤(PI)。我们的目的是分析成年患者最初确诊为PI(无功能微腺瘤)后,在第二次计算机断层扫描(CT)期间的动态变化。这是一项多中心、纵向、回顾性研究,纳入了成人(年龄在20至70岁之间)的真实世界数据。我们排除了有基线垂体激素过多或缺乏的患者,以及肿瘤大于1厘米的患者。共纳入117名成年人(94.02%为女性),平均年龄为43.86±11.99岁,随访时间为6至156个月,中位数(M)为40个月(四分位间距:13.50,72.00)。在PI诊断时,横径的平均值为0.53±0.16厘米,纵径平均值为0.41±0.13厘米,最大直径为0.55±0.16厘米。随访期间没有PI转变为功能性肿瘤,也没有出现垂体功能减退或直径增加>1厘米的情况。共有46/117(39.32%)的患者在随访期间直径增大(增大组=IG),而未增大组(非IG组;N=71,60.68%)包括直径稳定或减小的受试者。IG组的初始横径、纵径和最大直径均低于非IG组:分别为0.45±0.12与0.57±0.17(P<0.0001),0.36±0.11与0.43±0.13(P=0.004),0.46±0.12与0.6±0.16(P<0.0001)。IG组与非IG组相比,监测时间更长:中位数(四分位间距)为48(24,84)个月与32.5(12,72)个月(P=0.045),且在基线时年龄、垂体激素谱和肿瘤定位相似,直径变化中位数分别为+0.14厘米与-0.03厘米(P<0.0001)。相当高比例的患者在较长时间的随访中可能会出现PI直径增大,包括初始尺寸较小的患者,而诊断时的年龄并不能预测肿瘤生长。这可能有助于医生制定进一步的长期监测方案。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/44e5/11507025/06078c67ebe7/diseases-12-00240-g001.jpg

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