垂体神经内分泌肿瘤发生神经精神障碍研究进展  

Research progress of neuropsychiatric disorder in pituitary neuroendocrine tumor

作　　者：陈赛男 崔思远 王清 CHEN Sainan;CUI Siyuan;WANG Qing(The Affiliated Wuxi No.2 Hospital of Nanjing Medical University,Neurosurgery Department,No.68 Zhongshan Road,Liangxi District,Wuxi 214002,China)

机构地区：[1]南京医科大学,无锡临床医学院,南京210000 [2]南京医科大学附属无锡第二医院神经外科 [3]江南大学附属中心医院内分泌科

出　　处：《中国神经精神疾病杂志》2024年第6期369-374,共6页Chinese Journal of Nervous and Mental Diseases

基　　金：国家自然科学基金青年科学基金项目(编号:82000685);江苏省“十四五”医学重点学科基金(编号:ZDXK202227);江苏省自然科学基金面上项目(编号:BK20191140);无锡市卫健委科研项目-面上项目(编号:M202101)。

摘　　要：垂体神经内分泌肿瘤(pituitary neuroendocrine tumor,PitNET)是一类临床常见的颅内肿瘤,与神经精神障碍之间存在密切联系,PitNET患者常表现出抑郁、焦虑、认知功能障碍等神经精神症状,这些症状可能与激素分泌紊乱有关。经蝶窦手术切除是PitNET目前最常用的治疗方法,可改善患者的神经精神障碍;然而,用于治疗泌乳素(prolactin,PRL)瘤和生长激素(growth hormone,GH)腺瘤的多巴胺激动剂(dopamine agonists,DAs)可能引起或加重其神经精神症状;放射治疗则根据不同的放射剂量和辐射区域产生不同的结果。临床医生应注重筛查Pit‐NET患者并发神经精神障碍并给予及时干预,如因DAs治疗引起相关症状可根据具体情况以减量/停药并密切随访。This article seeks to delve into the correlation between pituitary neuroendocrine tumors(PitNET)and neuropsychiatric disorders while summarizing the most recent advancements in related research.Some patients with PitNET,benign tumors arising from pituitary gland cells,may develop specific clinical symptoms due to either tumor compression or abnormal hormone secretion.In recent years,investigators have identified a significant association between PitNET and neurological as well as psychiatric disorders.Patients with PitNET frequently manifest neurological and psychiatric symptoms,including depression,anxiety,and cognitive impairment,significantly impacting their quality of life and prognosis.These symptoms may be associated with distorted body image,hormonal imbalances,and inadequate treatment.The holistic approach to PitNET encompasses surgical intervention,radiation therapy,and drug therapy,each with its distinct set of advantages and drawbacks.Presently,transsphenoidal resection stands out as the most frequently employed method in treating PitNET to ameliorate the patient's neurological and psychiatric disorders.However,the use of dopamine agonists(DAs)in the treatment of prolactin(PRL)tumors and growth hormone(GH)adenomas may potentially induce or exacerbate neurological and psychiatric symptoms.The impact of radiation therapy on PitNET patients varies depending on the radiation dose and treatment area.Given that both the PitNET disease itself and its treatment may lead to neurological and psychiatric disorders,it is essential to assess and address the neurological and psychiatric status of all PitNET patients.Careful consideration should be given to PitNET patients with neurological and psychiatric disorders to determine whether these issues stem from dopamine agonist(DAs)treatment.The primary consideration should be given to patients with PRL microadenomas with normal PRL levels to minimize the dose of bromocriptine or cabergoline to the most effective level or even discontinue the medication with subsequent

关 键 词：垂体神经内分泌肿瘤 神经精神障碍 认知障碍 抑郁症 多巴胺激动剂 

分 类 号：R739.41[医药卫生—肿瘤]