ADENOMAS HIPOFISARIOS DE BAJA PREVALENCIA: UN ARTÍCULO DE REVISIÓN
DOI:
https://doi.org/10.51437/nj.v28i3.276Palabras clave:
Neoplasias hipofisarias, Adenohipófisis, Hormonas Adenohipofisarias, Diagnóstico.Resumen
RESUMEN
Introducción: Los adenomas hipofisarios constituyen un diverso grupo de neoplasias intracraneales, los cuales destacan por sus amplias manifestaciones clínicas relacionadas a los síndromes endocrinológicos secundarios y el compromiso neurológico, resaltando como una de las neoplasias más interesantes en el ámbito de la neurocirugía. Existe abundante literatura respecto a los grupos más frecuentes de adenomas hipofisarios, sin embargo sus integrantes menos comunes tienden a quedar en el olvido, razón por lo cual se realizó una revisión de la literatura con el objetivo de recopilar la información disponible, unificando la fisiopatología, diagnóstico y manejo dentro de un artículo que provea al lector las herramientas necesarias para el correcto abordaje de los grupos de adenomas menos frecuentes.
Materiales y métodos: Se realizó una búsqueda en las principales bases de datos científicas con términos MeSH durante diciembre 2020- Julio 2021.
Conclusiones:
A pesar de constituir patologías de baja frecuencia estas pueden generar un compromiso severo en la calidad de vida de los pacientes, que en gran parte podría ser prevenido con un diagnóstico temprano de las alteraciones endocrinológicas y su compromiso neurológico y una rápida remisión a servicios especializados. Sin embargo constituyen un reto diagnóstico, secundario a la amplia desinformación con respecto a estos grupos tumorales y sus manifestaciones clínicas, las cuales pueden asemejarse muchas veces a patologías de alta frecuencia dentro de la población general.
Citas
AlMalki, M.H., Ahmad, M.M., Brema, I., AlDahmani, K.M., Pervez, N., Al-Dandan,
S. et al l. 2020. Contemporary Management of Clinically Non-functioning
Pituitary Adenomas: A Clinical Review. Clinical Medicine Insights: Endocrinology
and Diabetes Jun;13:117955142093292-1179551420932921. https://doi.org/
1177/1179551420932921
Arafah, B.M. 1986. Reversible hypopituitarism in patients with large
nonfunctioning pituitary adenomas. J Clin Endocrinol Metab 62: 1173–1179.
https://doi.org/ 10.1210/jcem-62-6-1173
Black PM, Hsu DW, Klibanski A, Kliman B, Jameson JL, Ridgway EC, Hedley-White
ET, Zervas NT. 1987. Hormone production in clinically nonfunctioning pituitary
adenomas. J Neurosurg 66: 244–250. https://doi.org/
3171/jns.1987.66.2.0244
Beck-Peccoz, P., Brucker-Davis, F., Persani, L., Smallridge, R.C., Weintraub, B.D.
Thyrotropin-secreting pituitary tumors. Endocr Rev.;17:610–38.
https://doi.org/ 10.1210/edrv-17-6-610
Beck-Peccoz, P., Persani, L., Mannavola, D., Campi, I. 2009. Pituitary tumours:
TSH-secreting adenomas. Best Pract Res Clin Endocrinol Metab;23:597–606.
https://doi.org/ 10.1016/j.beem.2009.05.006.
Beck-Peccoz, P., Lania, A., Beckers, A., Chatterjee, K., Wemeau, J.2013 . 2013
European Thyroid Association Guidelines for the Diagnosis and Treatment ofNeurociencias Journal Vol 28 Núm 3 Henao S y Cols.
Página | 82
Thyrotropin-Secreting Pituitary Tumors. European thyroid journal Jun;2(2):76-
https://doi.org/ 10.1159/000351007
Biller, B.M., Findling, J.W., Murad, M.H., Newell-Pricem J,. Savage, M.O. et al. 1987.
Treatment of adrenocorticotropindependent Cushing’s syndrome: a consensus
statement. J Clin Endocrinol Metab 93:2454–2462, 2008. https://doi.org/
1210/jc.2007-2734
Chaudhary, V., Bano, S. 2011. Imaging of the pituitary: Recent advances. Indian
journal of endocrinology and metabolism Sep;15 Suppl 3(7):S216-S223.
https://doi.org/10.4103/2230-8210.84871
Cury, M. Fernandes, J.C., Machado, H.R., Elias, L.L., Moreira, A.C., Castro. M. 2009.
Non-functioning pituitary adenomas: clinical feature, laboratorial and imaging
assessment, therapeutic management and outcome. Arquivos brasileiros de
endocrinologia e metabologia Feb;53(1):31-39. https://doi.org/ 10.1590/s0004-
Daly, A.F,. Burlacu, M.C., Livadariu E.,Et al .2007. The Epidemiology and
Management of Pituitary Incidentalomas. Hormone research in paediatrics,
(5), pp. 195-198. . https://doi.org/ 10.1159/000110624
Dworakowska, D., Grossman, A. B. 2009. The pathophysiology of pituitary
adenomas. Best Practice & Research: Clinical Endocrinology & Metabolism
;23(5):525-541. https://doi.org/10.1016/j.beem.2009.05.004
Ebersold, M.J., Quast, L.M., Laws, E.R., Scheithauer, B., Randall, R.V. 1986. Longterm results in transsphenoidal removal of nonfunctioning pituitary adenomas.
J Neurosurg.;64:713-9. https://doi.org/ 10.3171/jns.1986.64.5.0713
Elster, A. D.1993. Imaging of the sella: Anatomy and pathology. Semin
Ultrasound CT MR. 1993;14:182–94. https://doi.org/10.1016/s0887-
(05)80079-4
Evanson, J. 2019. Radiology of the Pituitary. Encyclopedia of Endocrine Diseases,
Second Edition. Second Edition ed.: Elsevier Inc. p. 339-348.Neurociencias Journal Vol 28 Núm 3 Henao S y Cols.
Página | 83
Fukuhara, N., Horiguchi, K., Nishioka, H. et al. 2015. Short-term preoperative
octreotide treatment for TSH-secreting pituitary adenoma. Endocr J 62:21–27.
https://doi.org/ 10.1507/endocrj.EJ14-0118
Gao,R., Isoda, H., Tanaka, T., Inagawa, S., Takeda, H., Takehara, Y., et al. 2001.
Dynamic gadolinium enhanced MR imaging of pituitary adenomas: Usefulness
of sequential sagittal and coronal plane images. Eur J Radiol.;39:139–46.
https://doi.org/ 10.1016/s0720-048x(01)00354-0
Gilsanz, A., Moreno, B., Obiols, G., Zugasti, A., Català, M., Lucas, T. et al. 2006.
Guía clínica del diagnóstico y tratamiento de los tumores hipofisarios no
funcionantes y gonadotropinomas. Endocrinologia y nutricion;53(1):13-18.
https://doi.org/ 10.1016/S1575-0922(06)71060-9
Gittleman, H., Ostrom, Q.T., Farah. P.D., et al. 2014. Descriptive epidemiology of
pituitary tumors in the United States, 2004–2009. Journal of neurosurgery,
(3), pp. 527-535. . https://doi.org/ 10.3171/2014.5.JNS131819
Gurnell, M., Visser, T.J., Beck-Peccoz, P., Chatterjee, V.K.K. 2010. Resistance to
thyroid hormone; in Jameson LJ, DeGroot LJ (eds): Endocrinology, Adult and
Pediatric, ed 6. Philadelphia, Saunders Elsevier., vol II, pp 1745–1759
Halperin,R. Camara, R., Garcia, M., Ollero, D. 2012. Clinical guidelines for
diagnosis and treatment of prolactinoma and hyperprolactinemia.
Endocrinologia y nutrición (English ed.);60(6):308-319.
https://doi.org/10.1016/j.endonu.2012.11.005
Harris, P.E. 1988 Biochemical markers for clinically non-functioning pituitary
tumours. Clin Endocrinol;49:163-4. https://doi.org/ 10.1046/j.1365-
1998.00539.x
Ho K, Fleseriu M, Kaiser U, Salvatori R, Brue T. Lopes, MB, et al. 2021. Pituitary
Neoplasm Nomenclature Workshop: Does Adenoma Stand the Test of Time?
Journal of the Endocrine Society Mar 1,;5(3). . https://doi.org/
1210/jendso/bvaa205Neurociencias Journal Vol 28 Núm 3 Henao S y Cols.
Página | 84
Iglesias, P., Arcano, K., Triviño, V. et al. 2017. Prevalence, clinical features, and
natural history of incidental clinically non-functioning pituitary adenomas. Horm
Metab Res.;49:654-659. https://doi.org/ 10.1055/s-0043-115645
Jagannathan, J., Smith, R., DeVroom, H.L., Vortmeyer, A.O., Stratakis, C.A.,
Nieman, L.K. et al. 2009. Outcome of using the histological pseudocapsule as a
surgical capsule in Cushing disease. J Neurosurg 111:531–539.
https://doi.org/10.3171/2008.8.JNS08339
Katznelson, L., Laws, E.R., Melmed, S., Molitch, M.E., Murad, M.H., Utz, A.,et al.
Acromegaly: An Endocrine Society Clinical Practice Guideline. The journal
of clinical endocrinology and metabolism Nov;99(11):3933-3951.
https://doi.org/10.1210/jc.2014-2700
Koulouri, O., Moran, C., Halsall, D., Chatterjee, K., Gurnell, M. 2013. Pitfalls in the
measurement and interpretation of thyroid function tests. Best Pract Res Clin
Endocrinol Metab 27:745–762. https://doi.org/10.1016/j.beem.2013.10.003
Kovacs, K., Scheithauer, B.W., Horvath, E., Lloyd, R.V. et al. 1996. The World
Health Organization classification of adenohypophysial neoplasms. A proposed
five-tier scheme. Cancer;78:502-10. https://doi.org/ 10.1002/(SICI)1097-
(19960801)78:3<502::AID-CNCR18>3.0.CO;2-2
Lamberts, S.W.J., Nobels, F.R.2002 Clinically nonfunctioning pituitary tumours
and gonadotrophinomas. En: Wass JA, ShaletSM, editores. Oxford textbook
of endocrinology and diabetes.Oxford: Oxford University Press. p. 192-8.
Lonser, R.R., Nieman L., Oldfield, E.H. 2017. Cushing's disease: pathobiology,
diagnosis, and management. Journal of neurosurgery Feb;126(2):404-417
https://doi.org/ 10.3171/2016.1.JNS152119
Lopes, M.B.S. 2017. The 2017 World Health Organization classification of tumors
of the pituitary gland: a summary. Acta Neuropathol Oct;134(4):521-535.
https://doi.org/10.1007/s00401-017-1769-8
Losa, M., Giovanelli, M., Persani, L., Faglia, G., Beck-Peccoz, P. 1996. Criteria of
cure and follow-up of central hyperthyroidism due to thyrotropin-secreting
pituitary adenomas. J Clin Endocrinol Metab 81:3086–3090. https://doi.org/
1210/jcem.81.8.8768879Neurociencias Journal Vol 28 Núm 3 Henao S y Cols.
Página | 85
Losa, M., Mortini, P., Barzaghi, R., Franzin, A., Giovanelli, M. 2001. Endocrine
inactive and gonadotroph adenomas: diagnosis and management. J Neurooncol
Sep;54(2):167-177. https://doi.org/ 10.1023/a:1012965617685
Melmed S., Casanueva, F.F., Hoffman, A.R., Kleinberg, D.L., Montori, V.M.,
Schlechte, J.A. et al. 2011. Diagnosis and Treatment of Hyperprolactinemia: An
Endocrine Society Clinical Practice Guideline. The journal of clinical
endocrinology and metabolism Feb;96(2):273-288 https://doi.org/
1210/jc.2010-1692
Melmed, S. 2020. Pituitary-Tumor Endocrinopathies. The New England journal
of medicine Mar 5,;382(10):937-950. https://doi.org/10.1056/NEJMra1810772
Newell-Price, J.,Trainer, P., Besser, M., Grossman, A. 1998. The diagnosis and
differential diagnosis of Cushing’s syndrome and pseudoCushing’s states.
Endocr Rev; 19: 647–72. https://doi.org/ 10.1210/edrv.19.5.0346
Newell-Price J. , Bertagna, X., Grossman, A.B., Nieman, L.K. 2006. Cushing's
syndrome. The Lancet (British edition);367(9522):1605-1617.
https://doi.org/10.1016/S0140-6736(14)61375-1.
Nieman, L.K., Biller, B.M.K., Findling, J.W., Newell-Price, J., Savage, M.O., Stewart,
P.M., et al. 2008. The Diagnosis of Cushing's Syndrome: An Endocrine Society
Clinical Practice Guideline. The journal of clinical endocrinology and metabolism
May;93(5):1526-1540. https://doi.org/ 10.1210/jc.2008-0125
Nieman, L.K., Biller, B.M.K., Findling, J.W., Murad, M.H., Newell-Price, J., Savage,
M.O. et al. 2015. Treatment of Cushing's Syndrome: An Endocrine Society Clinical
Practice Guideline. The journal of clinical endocrinology and metabolism
Aug;100(8):2807-2831. https://doi.org/10.1210/jc.2015-1818
Nieman, L.K. 2018 .Recent Updates on the Diagnosis and Management of
Cushing's Syndrome. Endocrinology and metabolism (Seoul) Jun;33(2):139-146.
https://doi.org/ 10.3803/EnM.2018.33.2.139
Oldfield, E.H., Doppman, J.L., Nieman, L.K. et al.1991. Petrosal sinus sampling
with and without corticotropin-releasing hormone for the differential diagnosisNeurociencias Journal Vol 28 Núm 3 Henao S y Cols.
Página | 86
of Cushing’s syndrome. N Engl J Med; 325: 897–905. https://doi.org/
1056/NEJM199109263251301
Onnestam, L., Berinder, K., Burman, P., Dahlqvist, P., Engstrom, B.E., Wahlberg,
J., Nystrom, H.F. 2013. National incidence and prevalence of TSH-secreting
pituitary adenomas in Sweden. Journal of Clinical Endocrinology and
Metabolism. 98 626–635. https://doi.org/ 10.1210/jc.2012-3362
O’Sullivan, E.P., Woods, C., Glynn, N., et al. 2009. The natural history of surgically
treated but radiotherapy-naive nonfunctioning pituitary adenomas. Clin
Endocrinol;71:709-714. https://doi.org/ 10.1111/j.1365-2265.2009.03583.x.
Persani, L., Preziati, D., Matthews, C.H., Sartorio, A., Chatterjee, V.K., Beck-Peccoz,
P. 1997. Serum levels of carboxyterminal crosslinked telopeptide of type I
collagen (ICTP) in the differential diagnosis of the syndromes of inappropriate
secretion of TSH. Clinical Endocrinology 47 207–214. https://doi.org/
1046/j.1365- 2265.1997.2351057.x
Pickett, CA. 2003. Diagnosis and management of pituitary tumors: recent
advances. Primary care ;30(4):765-789. https://doi.org/10.1016/s0095-
(03)00094-0.
Raffi, ML., De Keyzer, Y,. Bertagna, X. 2003. Proopiomelanocortin, a polypeptide
precursor with multiple functions: from physiology to pathological conditions.
Eur J Endocrinol; 149: 79–90. https://doi.org/ 10.1530/eje.0.1490079
Reimondo, G,. Paccott,i P., Minetto, M. et al. 2003. The corticotrophinreleasing
hormone test is the most reliable noninvasive method to differentiate pituitary
from ectopic ACTH secretion in Cushing’s syndrome. Clin Endocrinol (Oxf); 58:
–24. https://doi.org/10.1046/j.1365-2265.2003.01776.x
Ross, E.J., Linch, D.C .1982. Cushing’s syndrome— killing disease: discriminatory
value of signs and symptoms aiding early diagnosis. Lancet 2:646 – 649.
https://doi.org/ 10.1016/s0140-6736(82)92749-0
Sheehan, J., Lee, C.C., Bodach, M.E., et al. 2016. Congress of neurological
surgeon’s systematic review and evidence-based guideline for the managementNeurociencias Journal Vol 28 Núm 3 Henao S y Cols.
Página | 87
of patients with residual or recurrent nonfunctioning pituitary adenomas.
Neurosurgery;79:E539-E540. https://doi.org/ 10.1227/NEU.0000000000001385
Socin, H.V., Chanson, P., Delemer, B., Tabarin, A., Rohmer, V., Mockel, J.,
Stevenaert, A., Beckers, A. 2003. The changing spectrum of TSHsecreting
pituitary adenomas: diagnosis and management in 43 patients. European
Journal of Endocrinology 148 433–442. https://doi.org/ 10.1530/eje.0.1480433
Tjörnstrand, A., Nyström, H.F. 2017. Diagnostic approach to TSH-producing
pituitary adenoma. European journal of endocrinology ;177(4):R183.
https://doi.org/ 10.1530/EJE-16-1029
Yamada, S., Fukuhara, N., Horiguchi, K., Yamaguchi-Okada, M., Nishioka, H.,
Takeshita, A., Takeuchi, Y., Ito, J., Inoshita, N. 2014. Clinicopathological
characteristics and therapeutic outcomes in thyrotropin-secreting pituitary
adenomas: a single-center study of 90 cases. Journal of Neurosurgery 121 1462–
https://doi.org/ 10.3171/2014.7.JNS1471