垂体偶发瘤诊断与治疗进展

Diagnosis and treatment of pituitary incidentalomas

垂体偶发瘤系与垂体病变无关的影像学检查偶然发现的垂体病变,包括垂体腺瘤、颅咽管瘤、Rathke囊肿和垂体增生等鞍区病变。随着影像学技术特别是MRI的广泛应用,越来越多的垂体偶发瘤被检出。目前针对垂体偶发瘤的定义、自然病程、首次诊断时干预指征、随访计划等,仍有诸多问题尚未解决,误诊、误治或过度治疗并不罕见。本文试图探讨垂体偶发瘤的定义、自然病程以及是否存在预测肿瘤自然病程的相关因素、明确诊断、手术指征、个体化随访计划等,以期引起临床重视并进行相关研究,进一步理清临床尚未解决的问题。

Pituitary incidentalomas(PIs)are defined as previously unexpected pituitary lesions which are accidentally discovered during imaging examinations performed for unrelated reasons,including pituitary adenoma,craniopharyngioma,Rathke's cyst,pituitary hyperplasia and other sellar lesions.With the wide application of imaging techniques,especially MRI,more and more pituitary incidentalomas have been detected.However,there are still many problems regarding the definition of pituitary incidentaloma,natural course of disease,intervention indication at the first diagnosis,follow⁃up plan,and so on,resulting in misdiagnosis and overtreatment.This review attempts to discuss the definition,relevant factors for predicting the natural course of tumor,diagnosis,surgical indications,and individualized follow⁃up plan,and so on,in order to attract clinical attention and conduct related research to further clarify the clinical unsolved problems.