Pituitary incidentaloma: an endocrine society clinical practice guideline.
Pituitary incidentaloma: an endocrine society clinical practice guideline.
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DOI：
10.1210/jc.2010-1048
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发表时间：
2011-04
期刊：
影响因子：
--
通讯作者：
Endocrine Society
中科院分区：
文献类型：
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作者：
Freda PU;Beckers AM;Katznelson L;Molitch ME;Montori VM;Post KD;Vance ML;Endocrine Society
介绍了垂体意外瘤的内分泌评估和治疗的实践指南，包括手术指征。其目的是为垂体偶发瘤的内分泌评估和治疗制定实践指南。通过一系列电话会议、电子邮件和一次面对面会议，对证据进行系统审查和讨论，从而达成共识。我们建议垂体偶发瘤患者进行完整的病史和体格检查，实验室评估，筛查激素分泌过多和垂体功能减退，如果病变邻近视神经或视交叉，则进行视野检查。我们建议对不符合手术切除标准的偶发瘤患者进行临床评估、神经影像学检查（大偶发瘤在6个月时进行磁共振成像，微小偶发瘤在1年时进行磁共振成像，此后如果大小不变，则频率逐渐降低），邻接或压迫视神经和视交叉的偶发瘤的视野检查（6个月和每年一次），并在初步评估后进行大偶发瘤的内分泌检测（6个月和每年一次）。我们建议垂体意外瘤患者在以下情况下应进行手术：视野缺损;肿瘤压迫导致其他视觉异常的体征，如眼肌麻痹，或因病变压迫导致的神经功能损害;病变邻接视神经或视交叉;垂体卒中伴视觉障碍;或意外瘤是泌乳素瘤以外的高分泌肿瘤。
Practice guidelines for the endocrine evaluation and treatment of pituitary incidentalomas are presented, including indications for surgery. The aim was to formulate practice guidelines for endocrine evaluation and treatment of pituitary incidentalomas. Consensus was guided by systematic reviews of evidence and discussions through a series of conference calls and e-mails and one in-person meeting. We recommend that patients with a pituitary incidentaloma undergo a complete history and physical examination, laboratory evaluations screening for hormone hypersecretion and for hypopituitarism, and a visual field examination if the lesion abuts the optic nerves or chiasm. We recommend that patients with incidentalomas not meeting criteria for surgical removal be followed with clinical assessments, neuroimaging (magnetic resonance imaging at 6 months for macroincidentalomas, 1 yr for a microincidentaloma, and thereafter progressively less frequently if unchanged in size), visual field examinations for incidentalomas that abut or compress the optic nerve and chiasm (6 months and yearly), and endocrine testing for macroincidentalomas (6 months and yearly) after the initial evaluations. We recommend that patients with a pituitary incidentaloma be referred for surgery if they have a visual field deficit; signs of compression by the tumor leading to other visual abnormalities, such as ophthalmoplegia, or neurological compromise due to compression by the lesion; a lesion abutting the optic nerves or chiasm; pituitary apoplexy with visual disturbance; or if the incidentaloma is a hypersecreting tumor other than a prolactinoma.