Modernes Management von Hypophysenadenomen – gegenwärtiger Stand in Diagnostik, Therapie und Nachsorge
Abstract
Zusammenfassung. Hypophysenadenome (HA) sind gutartige Tumoren aus parenchymatösen Zellen des Hypopysenvorderlappens. Es wird zwischen endokrin-inaktiven HA und hormonsezernierenden HA differenziert. Die Symptomkonstellation ist abhängig von der hormonellen Über- oder Unterfunktion und dem durch das HA erzeugten Masseneffekt. Neben Kopfschmerzen präsentieren sich HA häufig mit Visusstörungen sowie Gesichtsfeldausfällen als Folge der Kompression des Chiasma opticum. Die chirurgische Resektion über einen transsphenoidalen Zugang ist die bevorzugte Therapieoption für symptomatische oder grössenprogrediente HA. Moderne Techniken wie intraoperative hochauflösende MR-Bildgebung unterstützen den Chirurgen in der maximal sicheren Resektion. Eine Sonderrolle spielen symptomatische Prolaktinome, die in erster Linie medikamentös mit Dopaminagonisten therapiert werden sollten. Aufgrund der Komplexität der Erkrankung ist eine interdisziplinäre Betreuung der Patienten durch Neurochirurgen und Endokrinologen in einem Zentrum mit hohen Fallzahlen empfohlen.
Abstract. Pituitary adenomas (PA) are benign neoplasms originating from parenchymal cells of the anterior pituitary. Tumor mass effect can cause headaches, visual deficits by compression of the optic chiasm, and partial or complete hypopituitarism. Hormone secreting PA can cause several forms of specific syndromes such as Cushing’s disease or acromegaly depending on the type of hormone. Endoscopic transsphenoidal resection is the preferred treatment option for most symptomatic or growing PA. Nowadays techniques like high definition intraoperative MRI can assist the surgeon in his goal of maximal safe resection. An exception are prolactinomas which can usually be treated medically with dopamine agonists. Therapy of PA is complex and should be managed in a high-volume center with an interdisciplinary team approach including neurosurgeons and endocrinologists.
Résumé. Les adénomes hypophysaires (AH) sont des néoplasmes bénins provenant de cellules parenchymateuses de l’hypophyse antérieure. L’effet de masse tumorale peut provoquer des maux de tête, un déficit visuel par compression du chiasma optique et un hypopituitarisme sélectif ou pan-hypophysaire. Les AH hormone sécrétant peuvent provoquer plusieurs formes d’hyperpituitarisme en fonction du type d’hormone. La résection trans-sphénoïdale endoscopique est l’option de traitement préférée pour la plupart des AH symptomatiques ou en croissance. De nos jours, des techniques telles que l’IRM intra opératoire peuvent aider le chirurgien dans son objectif de résection sûre. Une exception sont les prolactinomes qui peuvent être traités médicalement avec des agonistes dopaminergiques. La thérapie des AH est complexe et devrait être gérée dans un centre à haut volume avec une approche d’équipe interdisciplinaire comprenant des neurochirurgiens et des endocrinologues.
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