保守管理的无功能垂体大腺瘤——来自英国无功能垂体腺瘤协会的队列研究。

IF 5.3 1区 医学 Q1 ENDOCRINOLOGY & METABOLISM
Athanasios Fountas, Kirstie Lithgow, Paul Benjamin Loughrey, Efstathios Bonanos, Shah Khalid Shinwari, Kirsten Mitchell, Akash Mavilakandy, Masato Ahsan, Mike Matheou, Kristina Isand, Ross Hamblin, David S McLaren, Hafiz Zubair Ullah, Lydia Grixti, James MacFarlane, Anuradha Jayasuriya, Sumbal Bhatti, Wunna Wunna, Syed Shah, Ziad Hussein, Susan Mathew, Katarina Klaucane, John Ayuk, Andy Toogood, Georgios Tsermoulas, Shahzada Ahmed, Alessandro Paluzzi, Ruchika Batra, Joannis Vamvakopoulos, Amutha Krishnan, Claire Higham, Prakash Abraham, Stephanie E Baldeweg, Tejpal Purewal, Janki Panicker, Niamh Martin, William M Drake, Rupa Ahluwalia, John Newell-Price, Mark Gurnell, Yaasir Mamoojee, Antonia Brooke, Andrew Lansdown, Robert D Murray, Karin Bradley, Aparna Pal, Narendra Reddy, Miles J Levy, Ellen Marie Freel, Biju Jose, Steven J Hunter, Niki Karavitaki
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引用次数: 0

摘要

目的:无症状无功能垂体大腺瘤(macronfpa)常采用监测。由于证据质量低,成像/生化监测的最佳频率和手术指征仍然存在不确定性。我们评估了从英国NFPA协会获得监测作为初始治疗选择的macroNFPA患者的自然病史和结局。设计:涉及21个英国内分泌科的多中心、回顾性、队列研究。方法:对2005年1月1日至2022年3月1日随访的949例患者的临床、影像学、激素资料进行分析。结果:随访6个月、1年、2年、3年、5年时,肿瘤增大的发生率为9.8 / 100患者年(95%CI, 8.8-10.8),累积概率分别为1.6%、8.1%、18.4%、29.2%、43.6%;肿瘤靠近或移位视交叉(OC)的发生率高于未接触视交叉的肿瘤。在未与OC接触的macrofpa中,在六个月内出现扩大的情况,没有影响视野。在扩大并持续监测的肿瘤中(中位数为2.6年),60.5%的肿瘤进一步生长(2年的概率为33.8%),35.5%的肿瘤稳定,4.0%的肿瘤缩小。新发垂体激素缺乏率为4.0% ~ 4.9%,主要由肿瘤扩大引起。经蝶窦手术后,垂体功能减退逆转率为12%-17%,垂体前叶激素缺乏率为12%-15%(永久性加压素缺乏率为3.5%)。结论:我们的数据为监测方案提供了证据。与OC不接触的macronfpa不需要频繁的成像,第一次随访扫描可以延迟到一年。首次肿大后,可出现不同的肿瘤行为。稳定肿瘤的新垂体功能低下是罕见的,挑战了定期评估垂体功能的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Conservatively managed non-functioning pituitary macroadenomas-cohort study from the UK Non-functioning Pituitary Adenoma Consortium.

Objective: Surveillance is often adopted for asymptomatic non-functioning pituitary macroadenomas (macroNFPAs). Due to low-quality evidence, uncertainty remains on optimal frequency of imaging/biochemical monitoring and indications for surgery. We assessed the natural history and outcomes of patients with macroNFPA who had monitoring as initial management choice from the UK NFPA Consortium.

Design: This was a multicentre, retrospective, cohort study involving 21 UK endocrine departments.

Methods: Clinical, imaging, and hormonal data of 949 patients followed up between January, 1, 2005 and March, 1, 2022 were analysed.

Results: Incidence rate for tumour enlargement was 9.8 per 100 patient-years (95% CI, 8.8-10.8), with cumulative probabilities 1.6%, 8.1%, 18.4%, 29.2%, and 43.6% at 6-month, 1-year, 2-year, 3-year, and 5-year follow-up, respectively; rates were higher in tumours abutting/displacing optic chiasm than those not in contact with it. Amongst macroNFPAs not in contact with optic chiasm showing enlargement within 6 months, none impacted visual fields. In tumours with enlargement and continued monitoring (median 2.6 years), further growth occurred in 60.5% (33.8% probability at 2 years), stability in 35.5%, and shrinkage in 4.0%. Rates of new pituitary hormone deficits were 4.0%-4.9%, mainly driven by tumour enlargement. After transsphenoidal surgery, rates of hypopituitarism reversal were 12%-17% and those of additional anterior pituitary hormone deficits were 12%-15% (permanent vasopressin deficiency 3.5%).

Conclusions: Our data provide evidence for monitoring protocols. MacroNFPAs not in contact with optic chiasm require less frequent imaging, and first follow-up scan can be delayed to 1 year. After first enlargement, variable tumour behaviour can occur. New hypopituitarism in stable tumours is rare, challenging necessity of regular pituitary function assessment.

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来源期刊
European Journal of Endocrinology
European Journal of Endocrinology 医学-内分泌学与代谢
CiteScore
9.80
自引率
3.40%
发文量
354
审稿时长
1 months
期刊介绍: European Journal of Endocrinology is the official journal of the European Society of Endocrinology. Its predecessor journal is Acta Endocrinologica. The journal publishes high-quality original clinical and translational research papers and reviews in paediatric and adult endocrinology, as well as clinical practice guidelines, position statements and debates. Case reports will only be considered if they represent exceptional insights or advances in clinical endocrinology. Topics covered include, but are not limited to, Adrenal and Steroid, Bone and Mineral Metabolism, Hormones and Cancer, Pituitary and Hypothalamus, Thyroid and Reproduction. In the field of Diabetes, Obesity and Metabolism we welcome manuscripts addressing endocrine mechanisms of disease and its complications, management of obesity/diabetes in the context of other endocrine conditions, or aspects of complex disease management. Reports may encompass natural history studies, mechanistic studies, or clinical trials. Equal consideration is given to all manuscripts in English from any country.
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