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Медикаментозная терапия инциденталом гипофиза

Анализ литературы показал, что несмотря на наличие теоретической основы для использования медикаментозной терапии инциденталом –присутствие активных рецепторов в опухолевой ткани, лекарственные препараты не нашли широкого применения. У пациентов с инциденталомами и сопутствующим умеренным повышением уровняпролактина, гиперпролактинемия может быть скорректирована назначением агонистов дофамина (58). В отличие от пролактином,указанные препараты не предназначены для уменьшения размеров инциденталомы, которые редко подвергаются обратному развитию. Критерием эффективности медикаментозной терапии считается уменьшение размеров опухолевой ткани более чем на 25-30% (63). В ряде работ рассматривалась возможность назначения агонистов дофамина пациентам с инциденталомами гипофиза с целью уменьшения размера образования. На фоне приема агонистов дофамина – каберголина или бромокриптин, уменьшение объемов образования наблюдалось в течение 1 года наблюдалось в 10-21,2 % случаев(42-44).Противоречивые результаты могут быть обусловлены применением различных препаратов и доз агонистов дофамина, а также наличием или отсутствием дофаминовых рецепторов в ткани опухоли.

Изучалась возможность применения аналогов соматостатина в лечении инциденталом гипофиза, учитывая что рецепторы соматостатина присутствуют во многих инциденталомах гипофиза (преимущественно 2 типа). При назначении препарата в течение 1 года уменьшение размеров наблюдалось в 5-25%, увеличение в 12%, стабилизация в 83% (45-48). Предпринимались попытки назначения комбинированной терапии агонистами дофамина и аналогами соматостатина. При применении сочетанной терапии октреотидоми каберголиному 60% пациентов наблюдалось уменьшение размеров опухоли на 10%. В другом исследовании, в которое было включено 10 пациентов, перенесших нейрохирургическоелечение без положительного эффекта, использовались пролонгированные формы октреотида и каберголин по 0,5 мг через в день в течение 6 месяцев. Отмечалось значимое уменьшение размеров образования (более 30%), сопровождавшееся улучшением зрительной функции (72).

Эксперты рабочей группы убеждены, что оказание медицинской помощи согласно Федеральным клиническим рекомендациям может существенно повысить ее эффективность. Однако данные рекомендации требуют персонифицированного подхода - тщательной оценки индивидуальных особенностей пациента, результатов лабораторно-инструментального обследования, на основании чего лечащий врач самостоятельно должен выработать оптимальную тактику ведения пациента.

Список использованной литературы:

1. AtkinsD, BestD, BrissPA, EcclesM, Falck-YtterY, FlottorpS, GuyattGH, HarbourRT, HaughMC, HenryD, HillS, JaeschkeR, LengG, LiberatiA, MagriniN, MasonJ, MiddletonP, MrukowiczJ, O’ConnellD, OxmanAD, PhillipsB, SchünemannHJ, EdejerTT, VaronenH, VistGE, WilliamsJrJW, ZazaS 2004 Gradingqualityofevidenceandstrengthofrecommendations. BMJ 328:1490

2. Swiglo BA, Murad MH, Schünemann HJ, Kunz R, Vigersky RA, Guyatt GH, Montori VM 2008 a case for clarity, consistency, and helpfulness: state-of-the-art clinical practice guidelines in endocrinology using the grading of recommendations, assessment, development, and evaluation system. J Clin endocrinol Metab 93:666–673

3. Fernandez-BalsellsMMM, BarwiseA, Gallegos-OrozcoJ, PaulA, LaneM, CarpioI, Perestelo-PerezLI, PoncedeLeonLovatonP, Erwin, P, CareyJ, MontoriVM 2010 Thenaturalhistoryofpituitaryincidentalomas: asystematicreviewandmeta-analysis. J Clin endocrinol Metab (in press)

4. Feldkamp J, Santen R, Harms E, Aulich A, Mödder U, Scherbaum WA 1999 incidentally discovered pituitary lesions: high frequency of macroadenomas and hormone- secreting adenomas—results of a prospective study. Clin endocrinol (Oxf) 51:109–113

5. AritaK, TominagaA, SugiyamaK, EguchiK, IidaK, SumidaM, MigitaK, KurisuK 2006 naturalcourseofincidentallyfoundnonfunctioningpituitaryadenoma, withspecialreferencetopituitaryapoplexyduringfollow-upexamination. J neurosurg 104:884–891

6. SannoN, OyamaK, TaharaS, TeramotoA, KatoY 2003 asurveyofpituitaryincidentalomainJapan. eurJendocrinol 149:123–127

7. FainsteinDayP, GuitelmanM, ArteseR, FiszledjerL, ChervinA, VitaleNM, StalldeckerG, DeMiguelV, Cornaló D, AlfieriA, SusanaM, GilM 2004 Retrospectivemulticentricstudyofpituitaryincidentalomas. Pituitary 7:145–148

8. Reincke M, Allolio B, Saeger W, Menzel J, Winkelmann W 1990 The ‘incidentaloma’ of the pituitary gland. is neuro- surgery required? JaMa 263:2772–2776

9. Donovan LE, Corenblum B 1995 The natural history of the pituitary incidentaloma. arch intern Med 155:181–183

10. Freda PU, Post KD 1999 differential diagnosis of sellar masses. endocrinol Metab Clin north am 28:81–117, vi

11. Zada G, Lin N, Ojerholm E, Ramkissoon S, Laws ER Craniopharyngioma and other cystic epithelial lesions of the sellar region: a review of clinical, imaging, and histopatho- logical relationships. neurosurg Focus 28:e4

12. Kanter AS, Sansur CA, Jane Jr JA, Laws Jr ER 2006 Rathke’s cleft cysts. Front Horm Res 34:127–157

13. BlackPM, HsuDW, KlibanskiA, KlimanB, JamesonJL, RidgwayEC, Hedley-WhyteET, ZervasNT 1987 Hormoneproductioninclinicallynonfunctioningpituitaryadenomas. J neurosurg 66:244–250

14. EsiriMM, AdamsCB, BurkeC, UnderdownR 1983 Pituitaryadenomas: immunohistologyandultrastructuralanalysisof 118 tumors. actaneuropathol 62:1–14

15. Al-Shraim M, Asa SL 2006 The 2004 World Health Organi- zation classification of pituitary tumors: what is new? acta neuropathol 111:1–7

16. Molitch ME 2008 nonfunctioning pituitary tumors and pituitary incidentalomas. endocrinol Metab Clin north am 37:151–171, xi

17. Wolpert SM, Molitch ME, Goldman JA, Wood JB 1984 size, shape, and appearance of the normal female pituitary gland. aJR am J Roentgenol 143:377–381

18. Chambers EF, Turski PA, LaMasters D, Newton TH 1982 Regions of low density in the contrast-enhanced pituitary gland: normal and pathologic processes. Radiology 144:109–113

19. PeysterRG, AdlerLP, ViscarelloRR, HooverED, SkarzynskiJ 1986 CTofthenormalpituitarygland. neuro- radiology 28:161–165

20. Hall WA, Luciano MG, Doppman JL, Patronas NJ, Oldfield EH 1994 Pituitary magnetic resonance imaging in normal human volunteers: occult adenomas in the general population. ann intern Med 120:817–820

21. Nammour GM, Ybarra J, Naheedy MH, Romeo JH, Aron DC 1997 incidental pituitary macroadenoma: a population- based study.amJ Med sci 314:287–291

22. Yue NC, Longstreth Jr WT, Elster AD, Jungreis CA, O’Leary DH, Poirier VC 1997 Clinically serious abnormali- ties found incidentally at MR imaging of the brain: data from the Cardiovascular Health study. Radiology 202:41–46

23. Igarashi T, Saeki N, Yamaura A 1999 long-term magnetic resonance imaging follow-up of asymptomatic sellar tumors— their natural history and surgical indications. neurol Med Chir (Tokyo) 39:592–598; discussion 598–599

24. Karavitaki N, Collison K, Halliday J, Byrne JV, Price P, Cudlip S, Wass JA 2007 What is the natural history of nonoperated nonfunctioning pituitary adenomas? Clin endocrinol (Oxf) 67:938–943

25. DekkersOM, HammerS, deKeizerRJ, RoelfsemaF, SchuttePJ, SmitJW, RomijnJA, PereiraAM 2007 Thenaturalcourseofnonfunctioningpituitarymacroadenomas. eurJendocrinol 156:217–224

26. Nishizawa S, Ohta S, Yokoyama T, Uemura K 1998 Therapeutic strategy for incidentally found pituitary tumors (“pituitary incidentalomas”). neurosurgery 43:1344–1348; discussion 1348–1350, an endocrine Society clinical Practice Guideline

27. Daly AF, Rixhon M, Adam C, Dempegioti A, Tichomirowa MA, Beckers A 2006 High prevalence of pituitary adenomas: a crosssectional study in the province of liege, Belgium. J Clin endocrinol Metab 91:4769–4775

28. Fernandez A, Karavitaki N, Wass JA Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, uK). Clin endocrinol (Oxf) 72:377–382

29. Raappana A, Koivukangas J, Ebeling T, Pirilä T 2010 incidence of pituitary adenomas in northern Finland in 1992–2007. J Clin endocrinol Metab 95:4268–4275

30. Buurman H, Saeger W 2006 subclinical adenomas in postmortem pituitaries: classification and correlations to clin- ical data. eur J endocrinol 154:753–758

31. Casanueva FF, Molitch ME, Schlechte JA, Abs R, Bonert V, Bronstein MD, Brue T, Cappabianca P, Colao A, Fahl- busch R, Fideleff H, Hadani M, Kelly P, Kleinberg D, Laws E, Marek J, Scanlon M, Sobrinho LG, Wass JA, Giustina A 2006 Guidelines of the Pituitary society for the diagnosis and management of prolactinomas. Clin endocrinol (Oxf) 65:265–273

32. Angeli A, Terzolo M 2002 adrenal incidentaloma—a modern disease with old complications. J Clin endocrinol Metab 87:4869–4871

33. NiemanLK, BillerBM, FindlingJW, Newell-PriceJ, SavageMO, StewartPM, MontoriVM 2008 ThediagnosisofCushing’ssyndrome: anendocrinesocietyClinicalPracticeGuideline. J Clin endocrinol Metab 93:1526–1540

34. KaravitakiN, AnsorgeO, WassJA 2007 silentcortico- trophadenomas. arqBrasendocrinolMetabol 51:1314–1318

35. YuenKC, CookDM, SahasranamP, PatelP, GhodsDE, ShahinianHK, FriedmanTC 2008 PrevalenceofGHandotheranteriorpituitaryhormonedeficienciesinadultswithnonsecretingpituitarymicroadenomasandnormalserumiGF-1 levels. Clin endocrinol (Oxf) 69:292–298

36. Molitch ME, Clemmons DR, Malozowski S, Merriam GR, Shalet SM, Vance ML, Stephens PA 2006 evaluation and treatment of adult growth hormone deficiency: an endocrine society Clinical Practice Guideline. J Clin endocrinol Metab 91:1621–1634

37. Gruber A, Clayton J, Kumar S, Robertson I, Howlett TA, Mansell P 2006 Pituitary apoplexy: retrospective review of 30 patients—is surgical intervention always necessary? Br J neurosurg 20:379–385

38. Barker 2nd FG, Klibanski A, Swearingen B 2003 Transs- phenoidal surgery for pituitary tumors in the united states, 1996–2000: mortality, morbidity, and the effects of hospital and surgeon volume. J Clin endocrinol Metab 88:4709–4719

39. Gittoes NJ, Sheppard MC, Johnson AP, Stewart PM 1999 Outcome of surgery for acromegaly—the experience of a dedicated pituitary surgeon. QJM 92:741–745 \

40. Arafah BM, Kailani SH, Nekl KE, Gold RS, Selman WR 1994 immediate recovery of pituitary function after transs- phenoidal resection of pituitary macroadenomas. J Clin endocrinol Metab 79:348–354

41. Arafah BM 1986 Reversible hypopituitarism in patients with large nonfunctioning pituitary adenomas. J Clin endocrinol Metab 62: 1173–1179

42. GreenmanY, TordjmanK, OsherE, VeshchevI, Shen- kermanG, Reider-GroswasserII, SegevY, OuaknineG, SternN 2005 Postoperativetreatmentofclinicallynonfunc- tioningpituitaryadenomaswithdopamineagonistsdecreasestumourremnantgrowth. Clin endocrinol (Oxf) 63:39–44

43. Lohmann T, Trantakis C, Biesold M, Prothmann S, Guenzel S, Schober R, Paschke R 2001 Minor tumour shrinkage in nonfunctioning pituitary adenomas by long- term treatment with the dopamine agonist cabergoline. Pituitary 4:173–178

44. PivonelloR, MatroneC, FilippellaM, CavalloLM, DiSommaC, CappabiancaP, ColaoA, AnnunziatoL, LombardiG 2004 dopaminereceptorexpressionandfunc- tioninclinicallynonfunctioningpituitarytumors: compar- isonwiththeeffectivenessofcabergolinetreatment. J Clin endocrinol Metab 89:1674–1683

45. Shomali ME, Katznelson L 2002 Medical therapy of gonad- otropin-producing and nonfunctioning pituitary adenomas. Pituitary 5:89–98

46. MerolaB, ColaoA, FeroneD, SelleriA, DiSarnoA, MarzulloP, BiondiB, SpazianteR, RossiE, LombardiG 1993 effectsofachronictreatmentwithoctreotideinpatientswithfunctionlesspituitaryadenomas. Horm Res 40:149–155

47. deBruinTW, KwekkeboomDJ, Van’tVerlaatJW, ReubiJC, KrenningEP, LambertsSW, CroughsRJ 1992 Clini- callynonfunctioningpituitaryadenomaandoctreotideresponsetolongtermhighdosetreatment, andstudiesinvitro. J Clin endocrinol Metab 75:1310–1317

48. ColaoA, DiSommaC, PivonelloR, FaggianoA, LombardiG, SavastanoS 2008 Medicaltherapyforclinicallynon- functioningpituitaryadenomas. endocrRelatCancer 15:905–915

49. Molitch ME 1995 Clinical review 65. evaluation and treat- ment of the patient with a pituitary incidentaloma. J Clin endocrinol Metab 80:3–6

50. Вакс В. В., Кадашев С. Ю., Касумова С. Ю. Отдаленные результаты послеоперационного лечения при «неактивных» аденомах гипофиза // Проблемы эндокринологии. 2001, № 1, с. 16–19.

51. Вакс В.В. Клинически «неактивные» опухоли гипофиза: клинико-морфологические особенности, диагностики, лечения// Мат. Рос. науч.-практ. конф. «Заболевания гипоталамо-гипофизарной системы» / Под ред. акад. И.И. Дедова.— М., 2001. — С. 37-45.

52. Krikorian A & Aron D. Evaluation and management of pituitary incidentalomas – revisiting an acquaintance. Nature Clinical Practice. Endocrinology & Metabolism 2006; 2: 138–145.

53. Chanson P & Young J. Pituitary incidentalomas. The Endocrinologist 2003; 13: 124–135.

54. Arnaldi G, Angeli A, Atkinson AB et al. Diagnosis and complications of Cushing’s syndrome: a consensus statement. The Journal of Clinical Endocrinology and Metabolism2003; 88: 5593–5602.

55. Findling JW & Raff H. Cushing’s syndrome: important issues in diagnosis and management. TheJournalofClinicalEndocrinologyandMetabolism 2006; 91: 3746–3753.

56. Carroll T, Raff H & Findling JW. Late-night salivary cortisol measurement in the diagnosis of Cushing’s syndrome. Nature Clinical Practice. Endocrinology & Metabolism 2008; 4: 344–350.

57. Angeli A, Terzolo M. Adrenal incidentaloma— a modern disease with old complications. J Clin Endocrinol Metab 2002;87:4869–71.

58. Вакс В.В., Дедов И.И. Возможности медикаментозной терапии опухолей гипофиза. // Вопросы нейрохирургии. – 2005 № 2 С. 30-37.

59. Кадашев Б.А. Аденомы гипофиза: клиника, диагностика, лечение. – Тверь, 2007.: ООО «Триада Х», 2007. — 368

60. Scheithauer BW, Jaap AJ, Horvath E, et al. Clinically silent corticotroph tumors of the pituitary gland. Neurosurgery 2000;47:723–9.

61. Bradley KJ, Wass JA, Turner HE. Non-functioning pituitary adenomas with positive immunoreactivity for ACTH behave more aggressively than ACTH immunonegative tumours but do not recur more frequently. Clin Endocrinol 2003;58:59–64.

62. Doerfler A & Richter G. Lesions within and around the pituitary. Much more than adenomas. Clinical Neuroradiology 2008; 18(1): 5–18.

63. Дедов И.И. Вакс В.В., Клиническая нейроэндокринологияя, Москва 2011, с 170-204

64. RaviThomas, KashinathaShenoy, MandalamSSeshadri, JayaprakashMuliyil, AmithaRao, PadmaPaulDepartmentofOphthalmology, LVPrasadEyeInstitute, LVPrasadMarg, BanjaraHills, Hyderabad-500 034, India. Indian Journal of Ophthalmology (Impact Factor: 1.02). 07/2002; 50(2):127-30.

65. Vernooij MW, Ikram A, Tanghe HL et al. Incidental findings on brain MRI in the general population. The New England Journal of Medicine 2007; 357: 1821–1828.

66. Chacko AG & Chandy MJ. Incidental pituitary macroadenomas. British Journal of Neurosurgery 1992; 6: 233–236.

67. Nishizawa S, Ohta S, Yokoyama T et al. Therapeutic strategy for incidentally found pituitary tumors (‘pituitary incidentalomas’). Neurosurgery 1998; 43: 1344–1348.

68. Igarashi T, Saeki N & Yamaura A. Long-term magnetic resonance imaging follow-up of asymptomatic sellar tumors. Their natural history and surgical indications. Neurologia Medico-Chirurgica 1999; 39: 592–599.

69. Dekkers OM, Pereira AM & Romijn JA. Treatment and follow-up of clinically nonfunctioning pituitary macroadenomas. The Journal of Clinical Endocrinology and Metabolism 2008; 93: 3717–3726.

70. Esen F, Demirci A, Sari A, Resit Gumele H. Pituitary dimensions and volume measurements in pregnancy and post partum. MR assessment. Acta Radiol 1998;39:64–69.

71. Вакс В.В., Дедов И.И. Возможности медикаментозной терапии опухолей гипофиза. // Вопросы нейрохирургии. – 2005 № 2 С. 30-37.

72. Colao A, Filippella M, Di Somma C, Manzi S, Rota F, Pivonello R, Gaccione M, De Rosa M & Lombardi G 2003 Somatostatin analogs in treatment of non-growth hormone- secreting pituitary adenomas. Endocrine 20 279–283.

73. Bronstein MD1, Paraiba DB, Jallad RS. Management of pituitary tumors in pregnancy, Nat. Rev Endocrinol. 2011 May;7(5):301-10.

74. Fleseriu M, Gassner M, Yedinak C et al. Normal hypothalamic-pituitary-adrenal axis by highdose cosyntropin testing in patients with abnormal response to low-dose cosyntropin stimulation: a retrospective review. Endocrine Practice 2010 Jan–Feb; 16(1): 64–70.

75. Van den Bergh AC, van den Berg G, Schoorl MA, Sluiter WJ, van der Vliet AM, Hoving EW, et al. Immediate postoperative radiotherapy in residual nonfunctioning pituitary adenoma: Beneficial effect on local control without additional negative impact on pituitary function and life expectancy. Int J Radiat Oncol Biol Phys 2007;67:863-9.

76. Park P, Chandler WF, Barkan AL, Orrego JJ, Cowan JA, Griffith KA, et al. The role of radiation therapy after surgical resection of nonfunctional pituitary macroadenomas. Neurosurgery 2004;55:100-6; discussion 106-7.

77. Lange M., Oeckler R., Muller O. Treatment of non-functioning adenoma remnants – radiotherapy or observation? J.Endocrinol.Invest.-1991.-Vol.14, Suppl.1.-P.46

78. Sheehan JP1, Starke RM, Mathieu D, Young B, Sneed PK, Chiang VL, Lee JY, Kano H, Park KJ, Niranjan A, Kondziolka D, Barnett GH, Rush S, Golfinos JG,Lunsford LD. Gamma Knife radiosurgery for the management of nonfunctioning pituitary adenomas: a multicenter study. J Neurosurg. 2013 Aug;119(2):446-56.

79. Cho CB, Park HK, Joo WI, Chough CK, Lee KJ, Rha HK. Stereotactic Radiosurgery with the CyberKnife for Pituitary Adenomas. J Korean Neurosurg Soc 2009;45:157-63.

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