Vol. 13. Núm. 15.
Páginas 821-832 (Septiembre 2020)

Actualización
Adenomas hipofisarios funcionantes

Functioning pituitary adenomas

M. Araujo-CastroaE. Pascual-CorralesaA.E. Ortiz-FloresabH.F. Escobar-Morrealeabc
Doi : https://10.1016/j.med.2020.09.001
Opciones
Resumen

Los adenomas hipofisarios funcionantes (AHF) son las lesiones hipofisarias más frecuentes. Los prolactinomas suponen el 40% de todos los adenomas hipofisarios y el 60% de los AHF. Los AHF cursan con síntomas secundarios al exceso de la hormona secretada y síntomas locales debido al efecto masa del tumor como cefalea, alteraciones visuales y/o hipopituitarismo. Los síndromes clínicos de hiperfunción hipofisaria son, principalmente, la hiperprolactinemia con el consecuente hipogonadismo secundario, la acromegalia, la enfermedad de Cushing y el hipertiroidismo secundario. Para establecer el diagnóstico de los AHF, el primer paso es demostrar bioquímicamente un exceso en la secreción de hormonas. Posteriormente se deben realizar pruebas de imagen para detectar el tumor, siendo la resonancia magnética (RM) con contraste la prueba de elección. El tratamiento quirúrgico representa la terapia de primera línea en la mayor parte de los AHF, salvo en los prolactinomas que suelen responder a agonistas dopaminérgicos (AD).

Palabras clave
Adenoma hipofisario
Adenoma hipofisario funcionante
Prolactinoma
Agonistas dopaminérgicos
Abstract

Functioning pituitary adenomas (FPA) are the commonest pituitary lesions. Prolactinomas account for approximately 40% of all pituitary adenomas and 60% of FPA. FPA's symptoms are caused by excessive hormone secretion as well as the compressive effect of tumor mass (headache, visual disturbances and/or hypopituitarism). The main clinical hyperfunctioning pituitary syndromes are: hyperprolactinemia and consequent secondary hypogonadism, acromegaly, Cushing's disease and secondary hyperthyroidism. Clinical diagnosis of FPA, requires, firstly to demonstrate biochemically an excessive hormone secretion. Then, in order to find the tumor, imaging tests have to be performed (contrast magnetic resonance imaging [MRI] is the test of choice). In most cases of FPA, surgery is the treatment of first line, except prolactinomas that usually respond to dopamine agonists (DA).

Keywords
Pituitary adenoma
Functioning pituitary adenomas
Prolactinoma
Dopamine agonists

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