Corticotroph tumor progression after bilateral adrenalectomy (Nelson's syndrome): systematic review and expert consensus recommendations.
Обработка статьи · этапы, ошибки и управление
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Reincke Martin, Albani Adriana, Assie Guillaume, Bancos Irina, Brue Thierry, Buchfelder Michael, Chabre Olivier, Ceccato Filippo, Daniele Andrea, Detomas Mario, Di Dalmazi Guido, Elenkova Atanaska, Findling James, Grossman Ashley B, Gomez-Sanchez Celso E, Heaney Anthony P, Honegger Juergen, Karavitaki Niki, Lacroix Andre, Laws Edward R, Losa Marco, Murakami Masanori, Newell-Price John, Pecori Giraldi Francesca, Pérez-Rivas Luis G, Pivonello Rosario, Rainey William E, Sbiera Silviu, Schopohl Jochen, Stratakis Constantine A, Theodoropoulou Marily, van Rossum Elisabeth F C, Valassi Elena, Zacharieva Sabina, Rubinstein German, Ritzel Katrin
Аннотация
METHODS: A systematic literature search was performed focusing on clinical studies and case series (≥5 patients). Definition, cumulative incidence, treatment and long-term outcomes of CTP/NS after BADX were analyzed using descriptive statistics. The results were presented and discussed at an interdisciplinary consensus workshop attended by international pituitary experts in Munich on October 28, 2018.
RESULTS: Data covered definition and cumulative incidence (34 studies, 1275 patients), surgical outcome (12 studies, 187 patients), outcome of radiation therapy (21 studies, 273 patients), and medical therapy (15 studies, 72 patients).
CONCLUSIONS: We endorse the definition of CTP-BADX/NS as radiological progression or new detection of a pituitary tumor on thin-section MRI. We recommend surveillance by MRI after 3 months and every 12 months for the first 3 years after BADX. Subsequently, we suggest clinical evaluation every 12 months and MRI at increasing intervals every 2-4 years (depending on ACTH and clinical parameters). We recommend pituitary surgery as first-line therapy in patients with CTP-BADX/NS. Surgery should be performed before extrasellar expansion of the tumor to obtain complete and long-term remission. Conventional radiotherapy or stereotactic radiosurgery should be utilized as second-line treatment for remnant tumor tissue showing extrasellar extension.