Fleseriu Maria, Gurnell Mark, McCormack Ann, Fukuoka Hidenori, Glezer Andrea, Langlois Fabienne, Schwartz Theodore H, Greenman Yona, Agrawal Nidhi, Akirov Amit, Bancos Irina, Capatina Cristina, Castinetti Frederic, Catalino Michael, Christ-Crain Mirjam, Das Liza, Drincic Andjela, Freda Pamela U, Gadelha Monica R, Giustina Andrea, Hanzu Felicia, Ho Ken K Y, Isand Kristina, Mallea-Gil Susana, Mamelak Adam N, Marcus Hani J, Uygur Meliha Melin, Molitch Mark, Nachtigall Lisa B, Nowak Elisabeth, Pereira Alberto M, Pineyro Maria M, Shafiq Ismat, Syro Luis, Takahashi Yutaka, Varlamov Elena V, Vila Greisa, Zada Gabriel, Karavitaki Niki, Melmed Shlomo
Oregon Health & Science University, Portland, OR, USA.
Institute of Metabolic Science, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Nat Rev Endocrinol. 2025 Jun 24. doi: 10.1038/s41574-025-01134-8.
This Pituitary Society Consensus article presents an evidence-based consensus on the management of pituitary incidentaloma, defined as an unexpected sellar or parasellar finding incidentally discovered on an imaging study that was not performed for a clinically suspected pituitary lesion. Recommendations are offered for when endocrinology, neurosurgery and ophthalmology consultation, dedicated pituitary imaging, pituitary hormone testing and visual assessment are warranted for macroadenomas, microadenomas, cystic lesions and empty sella, as well as when surgical resection is indicated for incidental pituitary adenomas and cystic sellar lesions. Special considerations in patients with multiple endocrine neoplasia type 1, children and adolescents, older people, and pregnant women are addressed. The Consensus workshop concluded that diagnostic and management approaches should be individualized to the specific clinical context of an incidentally discovered pituitary lesion. Consultation with a multidisciplinary pituitary tumour centre of excellence should be considered in the presence of new or deteriorating lesion-specific signs or symptoms, particularly when surgical or other adjuvant interventions are being considered and when there is uncertainty about the most appropriate subsequent management.
本垂体协会共识文章就垂体意外瘤的管理提出了基于证据的共识。垂体意外瘤定义为在并非针对临床疑似垂体病变而进行的影像学检查中偶然发现的意外鞍区或鞍旁发现。针对大腺瘤、微腺瘤、囊性病变和空蝶鞍，给出了何时需要内分泌科、神经外科和眼科会诊、专门的垂体成像、垂体激素检测和视力评估的建议，以及何时对垂体意外瘤和囊性鞍区病变进行手术切除的建议。还讨论了1型多发性内分泌肿瘤患者、儿童和青少年、老年人以及孕妇的特殊注意事项。共识研讨会得出结论，诊断和管理方法应根据偶然发现的垂体病变的具体临床情况进行个体化。在出现新的或恶化的病变特异性体征或症状时，应考虑咨询多学科垂体肿瘤卓越中心，特别是在考虑手术或其他辅助干预措施以及对最合适的后续管理存在不确定性时。
