Resumen
Epidemiología
Los adenomas hipofisarios constituyen el 10% de todas las neoplasias intracraneales. Entre los funcionantes los más frecuentes son los tumores secretores de hormona de crecimiento (GH) que causan la acromegalia, los tumores productores de prolactina (PRL) y los tumores productores de hormona corticotropa (ACTH) que causan la enfermedad de Cushing.
EtiopatogeniaLos adenomas hipofisarios son tumores benignos de la adenohipófisis de presentación esporádica generalmente, aunque pueden aparecer asociados a síndromes hereditarios.
Manifestaciones clínicasLos adenomas funcionantes producen síntomas derivados de la hormona de la adenohipófisis segregada en exceso. Además producen síntomas derivados del efecto masa y del hipopituitarismo asociado.
DiagnósticoEl diagnóstico se basa en las determinaciones hormonales y en las pruebas radiológicas.
TratamientoLa cirugía, el tratamiento farmacológico y la radioterapia constituyen la base del tratamiento.
Palabras clave
Acromegalia
Prolactinomas
Enfermedad de Cushing
Abstract
Epidemiology
Pituitary adenomas account for up to 10% of all intracranial neoplasms. The most common functioning tumors are those secreting growth hormone (GH) that cause acromegaly, prolactin (PRL) and adrenocorticotropic hormone (ACTH) that cause Cushing's disease.
EtiopathogenyPituitary adenomas are benign tumors of the anterior pituitary. Most of them present as sporadic but they may be associated to hereditary syndromes.
Clinical manifestationsPituitary adenomas produce symptoms related to the pituitary hormone secreted in excess. They also produce symptoms due to mass effect and secondary hypopituitarism.
DiagnosisThe diagnosis is based on hormonal tests and radiological imaging.
TreatmentSurgery, drug therapy and radiotherapy are the mainstay of treatment.
Keywords
Acromegaly
Prolactinoma
Cushing disease
Identifíquese
¿Aún no es suscriptor de la revista?
Comprar el acceso al artículo
Comprando el artículo el pdf del mismo podrá ser descargado
Teléfono para incidencias
De lunes a viernes de 9h a 18h (GMT+1) excepto los meses de julio y agosto que será de 9 a 15h
Llamadas desde España
932 415 960
Llamadas desde fuera de España
+34 932 415 960
Bibliografía
[2]
J Clin Invest., (2009), 119 pp. 3189-3202
[3]
Nat Rev Endocrinol, (2011), 7 pp. 257-266
[4]
A. Giustina, P. Chanson, M.D. Bronstein, A. Klibanski, S. Lamberts, F.F. Casanueva, et al.
A consensus on criteria for cure of acromegaly.
J Clin Endocrinol Metab., (2010), 95 pp. 3141-3148
[5]
L. Katznelson, J.L. Atkinson, D.M. Cook, S.Z. Ezzat, A.H. Hamrahian, K.K. Miller.
American Association of Clinical Endocrinologists medical guidelines for clinical practice for the diagnosis and treatment of acromegaly–2011 update: executive summary.
Endocr Pract., (2011), 17 pp. 636-646
[6]
S. Melmed, F.F. Casanueva, A. Klibanski, M.D. Bronstein, P. Chanson, S. Lamberts, et al.
A consensus on the diagnosis and treatment of acromegaly complications.
Pituitary, (2013), 16 pp. 294-302
[7]
L. Katznelson, E.R. Laws, S. Melmed, M.E. Molitch, M.H. Murad, A. Utz, J. Wass.
Acromegaly: An Endocrine Society Clinical Practice Guideline.
J Clin Endocrinol Metab., (2014), 99 pp. 3933-3951
[8]
Basal, but not pulsatile, growth hormone secretion determines the ambient circulating levels of insulin-like growth factor-I.
J Clin Endocrinol Metab., (2010), 95 pp. 2486-2491
[9]
A meta-analysis of the effect of lowering serum levels of GH and IGF-I on mortality in acromegaly.
Eur J Endocrinol., (2008), 159 pp. 89-95
[11]
P.U. Freda, L. Katznelson, A.J. van der Lely, C.M. Reyes, S. Zhao, D. Rabinowitz.
Long-acting somatostatin analog therapy of acromegaly: A meta-analysis.
J Clin Endocrinol Metab., (2005), 90 pp. 4465-4473
[12]
Place of cabergoline in acromegaly: a meta-analysis.
J Clin Endocrinol Metab., (2011), 96 pp. 1327-1335
[13]
A.J. Van der Lely, B.M. Biller, Y. Brue, M. Buchfelder, E. Ghigo, R. Gomez, et al.
Long-term safety of pegvisomant in patients with acromegaly: comprehensive review of 1288 subjects in ACROSTUDY.
J Clin Endocrinol Metab., (2012), 97 pp. 1589-1597
[14]
S.J. Neggers, W.W. de Herder, J.A. Janssen, R.A. Feelders, A.J. van der Lely.
Combined treatment for acromegaly with long-acting somatostatin analogs and pegvisomant: long-term safety for up to 4.5 years (median 2.2 years) of follow-up in 86 patients.
Eur J Endocrinol., (2009), 160 pp. 529-533
[15]
Outc ome of radiotherapy for acromegaly using normalization of insulin-like growth factor I to define cure.
J Clin Endocrinol Metab., (2000), 85 pp. 2068-2071
[16]
N Engl J Med., (2010), 362 pp. 1219-1226
[17]
Guía clínica del diagnóstico y tratamiento del prolactinoma y la hiperprolactinemia.
Endocrinol Nutr., (2013), 60 pp. 308-319
[18]
S. Melmed, F.F. Casanueva, A.R. Hoffman, D.L. Kleinberg, V.M. Montori, J.A. Schlechte, et al.
Diagnosis and treatment of hyperprolactinemia: an Endocrine Society Clinical Practice Guideline.
J Clin Endocrinol Metab., (2011), 96 pp. 273-288
[22]
Advances in the treatment of prolactinomas.
Endocr Rev., (2006), 27 pp. 485-534
[24]
Potential cardiac valve effects of dopamine agonists in hyperprolactinemia.
J Clin Endocrinol Metab., (2009), 94 pp. 2247-2249
[25]
Dopamine agonist therapy in prolactinomas: when can treatment be discontinued?.
J Clin Endocrinol Metab., (2009), 94 pp. 2247-2249
[26]
Recurrence of hyperprolactinemia after withdrawal of dopamine agonists: systematic review and meta-analysis.
J Clin Endocrinol Metab., (2010), 95 pp. 43-51
[28]
Epidemiology of Cushing's syndrome.
Neuroendocrinology, (2010), 92 pp. 1-5
[29]
L.K. Nieman, B.M. Biller, J.W. Findling, J. Newell-Price, M. Savage, P. Stewart, et al.
The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline.
J Clin Endocrinol Metab., (2008), 93 pp. 1526-1540
[30]
The diagnosis of Cushing's syndrome: an Endocrine Society Clinical Practice Guideline: commentary from a European perspective.
Eur J Endocrinol., (2000), 163 pp. 9-13
[31]
M.B. Elamin, M.H. Murad, R. Mullan, D. Erickson, K. Harris, S. Nadeem, et al.
Accuracy of diagnostic tests for Cushing's syndrome: a systematic review and metaanalyses.
J Clin Endocrinol Metab., (2008), 93 pp. 1553-1562
[32]
S. Salenave, B. Gatta, S. Pecheur, F. San-Galli, A. Visot, P. Lasjaunias, et al.
Pituitary magnetic resonance imaging findings do not influence surgical outcome in adrenocorticotropin– secreting microadenomas.
J Clin Endocrinol Metab., (2004), 89 pp. 3371-3376
[33]
S. Petersenn, A. Beckers, D. Ferone, A. van der Lely, J. Bollerslev, M. Boscaro, et al.
Therapy of endocrine disease: outcomes in patients with Cushing's disease undergoing transsphenoidal surgery: systematic review assessing criteria used to define remission and recurrence.
Eur J Endocrinol., (2015), 172 pp. R227-R239
[34]
B.M. Biller, A.B. Grossman, P.M. Stewart, S. Melmed, X. Bertagna, J. Bertherat, et al.
Treatment of adrenocorticotropin dependent Cushing's syndrome: a consensus statement.
J Clin Endocrinol Metab., (2008), 93 pp. 2454-2462
[35]
L.K. Nieman, B.M.K. Biller, J.W. Findling, M.H. Murad, J. Newell-Price, M.O. Savage, et al.
Treatment of Cushing's syndrome: an endocrine society clinical practice guideline.
J Clin Endocrinol Metab., (2015), 100 pp. 2807-2831
[36]
Results of gamma knife surgery for Cushing's disease.
J Neurosurg., (2013), 119 pp. 1486-1492
[37]
For The Aace Neuroendocrine And Pituitary Scientific Committee. AACE/ACE Disease State Clinical Review: medical management of Cushing disease.
Endocr Pract., (2014), 20 pp. 746-757
[40]
C. Baudry, J. Coste, R. Bou Khalil, S. Silvera, L. Guignat, J. Guibourdenche, et al.
Efficiency and tolerance of mitotane in Cushing's disease in 76 patients from a single center.
Eur J Endocrinol., (2012), 167 pp. 473-481
[41]
L. Vilar, L.A. Naves, M.F. Azevedo, M.J. Arruda, C.M. Arahata, E. Silva L. Moura, et al.
Effectiveness of cabergoline in monotherapy and combined with ketoconazole in the management of Cushing's disease.
Pituitary, (2010), 13 pp. 123-129
[42]
R. Van der Pas, R.A. Feelders, F. Gatto, C. de Bruin, A.M. Pereira, P.M. van Koetsveld, et al.
Preoperative normalization of cortisol levels in cushing's disease after medical treatment: consequences for somatostatin and dopamine receptor subtype expression and in vitro response to somatostatin analogs and dopamine agonists.
J Clin Endocrinol Metab., (2013), 98 pp. E1880-E1890
[43]
Successful long-term treatment of refractory Cushing's disease with high-dose mifepristone (RU 486).
J Clin Endocrinol Metab., (2001), 86 pp. 3568-3573
[44]
Pasireotide alone or with cabergoline and ketoconazole in Cushing's disease.
N Engl J Med., (2010), 362 pp. 1846-1848
[45]
P. Kamenický, C. Droumaguet, S. Salenave, A. Blanchard, C. Jublanc, J.F. Gautier, et al.
Mitotane, metyrapone, and ketoconazole combination therapy as an alternative to rescue adrenalectomy for severe ACTH-dependent Cushing's syndrome.
J Clin Endocrinol Metab., (2011), 96 pp. 2796-2804
