Guerrero-Pérez Fernando, Vega Rojas Natalia, Iglesias Pedro
Department of Endocrinology and Nutrition, Hospital Universitari de Bellvitge, Barcelona, Spain.
Biomedical Research Institute of Bellvitge (IDIBELL), L'Hospitalet de Llobregat, Carrer de La Feixa Llarga, S/N, 08907, Barcelona, Spain.
Rev Endocr Metab Disord. 2025 May 13. doi: 10.1007/s11154-025-09969-2.
The existing evidence on pituitary function impairment in non-neuroendocrine pituitary tumors (non-PitNETs) is limited and scattered. We performed a systematic review using PubMed, Embase, Scopus, and Cochrane of all reported studies that evaluated pituitary function in craniopharyngiomas, meningiomas, germinomas, pituitary lymphomas, pituicytomas, granular cell tumors, spindle cell oncocytomas, and pituitary metastases over the past 35 years. A total of 5,614 patients from 114 studies were analyzed. The weighted mean age was 35.01 ± 2.7 years (95% CI: 34.9-35.1) and 47.5 ± 14.1% (95% CI: 47.1-47.8) were women. The overall weighted proportion of hypopituitarism was 49.1 ± 24.2% (95% CI: 48.4-49.7) and arginine vasopressin deficiency (AVD) was 18.43 ± 16.6% (95% CI: 17.9-18.9). According to tumor type, prevalence of hypopituitarism was 67.3 ± 8.1% (95% CI: 66.5-68.9) for germinomas, 61.4 ± 20.8% (95% CI: 58.8-64.1) for metastases, 58.7 ± 22.2% (95% CI: 46.2-71.3) for lymphomas, 54.4 ± 30.8% (95% CI: 45.6-63.3) for pituicytomas, 53.8 ± 12.3% (95% CI: 47.5-59.8) for oncocytomas, 49.1 ± 17.2% (95% CI: 48.6-49.6) for craniopharyngiomas, 29.7 ± 16.6% (95% CI: 22.4-36.9) for granular cell tumors, and 11.5 ± 9.1% (95% CI: 10.8-12.3) for meningiomas. When comparing the most prevalent non-PitNETs, the weighted prevalence of hypopituitarism was higher in metastases compared to craniopharyngiomas (χ2 = 696.8, df = 1), p < 0.0001. Similarly, the weighted prevalence of hypopituitarism in craniopharyngiomas was higher compared to meningiomas (χ2 = 16,278.13, df = 1), p < 0.0001. In conclusion, non-PitNETs result in hypopituitarism in approximately half of the cases and AVD in nearly one-fifth. Pituitary metastases and craniopharyngiomas demonstrate greater local aggressiveness and a higher likelihood of disrupting hypothalamic-pituitary function compared to meningiomas.
关于非神经内分泌性垂体肿瘤（非垂体神经内分泌肿瘤，non-PitNETs）导致垂体功能损害的现有证据有限且分散。我们使用PubMed、Embase、Scopus和Cochrane对过去35年中所有评估颅咽管瘤、脑膜瘤、生殖细胞瘤、垂体淋巴瘤、垂体细胞瘤、颗粒细胞瘤、梭形细胞嗜酸细胞瘤和垂体转移瘤患者垂体功能的报告研究进行了系统评价。共分析了来自114项研究的5614例患者。加权平均年龄为35.01±2.7岁（95%CI：34.9 - 35.1），女性占47.5±14.1%（95%CI：47.1 - 47.8）。垂体功能减退的总体加权比例为49.1±24.2%（95%CI：48.4 - 49.7），精氨酸血管加压素缺乏（AVD）为18.43±16.6%（95%CI：17.9 - 18.9）。根据肿瘤类型，生殖细胞瘤患者垂体功能减退的患病率为67.3±8.1%（95%CI：66.5 - 68.9），转移瘤为61.4±20.8%（95%CI：58.8 - 64.1），淋巴瘤为58.7±22.2%（95%CI：46.2 - 71.3），垂体细胞瘤为54.4±30.8%（95%CI：45.6 - 63.3），嗜酸细胞瘤为53.8±12.3%（95%CI：47.5 - 59.8），颅咽管瘤为49.1±17.2%（95%CI：48.6 - 49.6），颗粒细胞瘤为29.7±16.6%（95%CI：22.4 - 36.9），脑膜瘤为11.5±9.1%（95%CI：10.8 - 12.3）。在比较最常见的非垂体神经内分泌肿瘤时，转移瘤患者垂体功能减退的加权患病率高于颅咽管瘤（χ2 = 696.8，自由度 = 1），p < 0.0001。同样，颅咽管瘤患者垂体功能减退的加权患病率高于脑膜瘤（χ2 = 16278.13，自由度 = 1），p < 0.0001。总之，非垂体神经内分泌肿瘤在大约一半的病例中导致垂体功能减退，近五分之一的病例出现精氨酸血管加压素缺乏。与脑膜瘤相比，垂体转移瘤和颅咽管瘤表现出更大的局部侵袭性，更有可能破坏下丘脑 - 垂体功能。
