Tumores hipofisarios no funcionantes: actualización 2012 |
| |
Institution: | 1. Urology Department, Hospital Clínic Barcelona, Spain;2. Urology Department, Fundación Sanitaria Hospital de Mollet, Barcelona, Spain;3. Radiology Department, Hospital Clínic Barcelona, Spain;4. Endocrinology Department, Hospital Vall d’Hebron Barcelona, Spain;5. Radiology Department, Hospital Parc Tauli Sabadell, Spain;6. Surgery and Urology Department, Hospital “Sf Pantelimon” Bucharest, Romania;1. Servicio de Endocrinología y Nutrición, Hospital Universitari Arnau de Vilanova, Lleida, España;2. Servicio de Endocrinología y Nutrición, Coorporació Sanitària Parc Taulí, Sabadell, España |
| |
Abstract: | Non-functioning pituitary adenomas are the most common pituitary macroadenomas in adults, accounting for approximately 14%-28% of all clinically relevant pituitary tumors. They are a heterogeneous group of tumors that cause symptoms by compression and/or hormone deficiencies. The possibility of tumor growth is increased in macroadenomas and solid tumors as compared to microadenomas and cystic tumors. Diagnosis is based on imaging procedures (magnetic resonance imaging), but there are studies reporting promising potential biomarkers. Transsphenoidal surgery remains the first therapeutic option for large tumors with compressive symptoms. There is no evidence that endoscopic procedures improve outcomes, but they decrease morbidity. There is no unanimity in finding prognostic predictors of recurrence. Radiosurgery achieves tumor control and, sometimes, adenoma size reduction. Its adverse effects increase with higher doses and tumor sizes > 4 cm3. Drug treatment is of little value. In aggressive non-functioning tumors, temozolomide (TMZ) may be used with caution because no controlled studies are available. TMZ achieves tumor control in 38%-40% of aggressive non-functioning tumors. The optimal treatment regimen and duration have not been defined yet. Lack of response to TMZ after 3 cycles predicts for treatment resistance, but initial response does not ensure optimal mid or long–term results. O6-methylguanine-DNA methyltransferase expression has a limited predictive value of response to treatment with TMZ in aggressive non-functioning tumors. It should therefore not be a determinant factor in selection of patients to be treated with TMZ. |
| |
Keywords: | Pituitary neoplasm Non-functioning pituitary adenoma Silent pituitary adenoma Pituitary incidentaloma Transsphenoidal surgery Radiotherapy Radiosurgery Pituitary carcinoma O6-methylguanine-DNA-methyltransferase immunoexpression Temozolomide |
本文献已被 ScienceDirect 等数据库收录! |
|