Sassolas G, Trouillas J, Treluyer C, Perrin G
Centre de Médecine Nucléaire, Hôpital Neurologique, Lyon, France.
Acta Endocrinol (Copenh). 1993 Jul;129 Suppl 1:21-6.
Clinically nonfunctioning pituitary adenomas represent one-third of pituitary tumours submitted to surgery. Symptoms consist mainly of visual impairment and there is no evidence of hormonal hypersecretion. Most nonfunctioning pituitary adenomas express genes of glycoprotein hormone subunit(s), and release these hormones in vitro. Thirty per cent of tumours do not synthesize any recognizable pituitary hormones. The first-line treatment is surgery, with the aim of removing as much of the tumour as possible and of reducing visual defects without excessive risks 80% of patients show visual improvement postoperatively. Tumour remnants exist in 30 to 50% of cases; radiation therapy is applied when tumour removal is incomplete. Recurrence of tumour and visual signs and/or an increase in the size of the tumour is noted in about 20% of cases even after radiation therapy. Medical treatment is used when tumour resection is impossible or hazardous. Long-term dopamine agonist treatment in a few cases can induce rapid and partial improvement and small decrease in tumour size in about 15%. Somatostatin analogues can induce an early visual improvement in limited cases, but little visible tumour shrinkage. GnRH analogues have been used in gonadotrophin-secreting tumours; super agonists seem unable to reduce secretion and tumour size.
临床无功能垂体腺瘤占接受手术治疗的垂体肿瘤的三分之一。症状主要包括视力损害，且无激素分泌过多的证据。大多数无功能垂体腺瘤表达糖蛋白激素亚基基因，并在体外释放这些激素。30%的肿瘤不合成任何可识别的垂体激素。一线治疗是手术，目的是尽可能多地切除肿瘤并减少视觉缺陷，同时避免过度风险。80%的患者术后视力改善。30%至50%的病例存在肿瘤残留；当肿瘤切除不完全时应用放射治疗。即使在放射治疗后，约20%的病例仍会出现肿瘤复发、视觉症状和/或肿瘤大小增加。当肿瘤切除不可能或有风险时采用药物治疗。少数病例长期使用多巴胺激动剂治疗可在约15%的患者中诱导快速部分改善和肿瘤大小小幅减小。生长抑素类似物在少数病例中可诱导早期视力改善，但肿瘤缩小不明显。促性腺激素释放激素类似物已用于促性腺激素分泌性肿瘤；超级激动剂似乎无法减少分泌和肿瘤大小。
