Patients with macroprolactinaemia: clinical and radiological features

BACKGROUND: Macroprolactinaemia may represent a relevant cause of misdiagnosis, unnecessary investigation and inappropriate treatment. The aim of this study was to investigate the clinical and neuroradiological characteristics of patients with and without macroprolactinaemia and to evaluate the impact of macroprolactin determination on the diagnostic work-up of hyperprolactinaemic patients. MATERIALS AND METHODS: Retrospective analysis in 135 consecutive hyperprolactinaemic patients (111 women and 24 men; mean age 37 +/- 11.6 years) whose archived sera were subsequently tested for macroprolactin. Recoveries 相似文献   

Headache associated with pituitary adenomas

The objectives of this study were to analyze the characteristics of headache in patients with pituitary adenoma and to investigate the mechanisms involved. Fifty-one patients (27 females and 24 males) with pituitary adenoma were examined. Nineteen (37.3%) of these patients (13 females and 6 males) had headache preoperatively. Most commonly, the headache was generalized (42.1%); overall headache was more frequent in the anterior half of the head (84.2%). Seventeen (89.5%) patients had bilateral headache. Headache was usually described as head heaviness (57.9%) and continuous (57.9%). Pulsating headache and dull pain were only reported by the female patients and were mostly intermittent. The mean age of patients with headache was younger than that of those without headache. Headache was more prevalent in patients with a prolactin-secreting adenoma (57.1%). There were no correlations between visual disturbances, hypopituitarism, tumor size, or cavernous sinus invasion and headache. Hemorrhagic pituitary adenoma in 4 (57.1%) of 7 patients did not always contribute to headache. The headache was improved after surgery in 14 (73.6%) of the 19 patients. In the male patients who survived postoperatively (5 of 6), headache was improved.     

Headache Associated With Pituitary Adenomas

The objectives of this study were to analyze the characteristics of headache in patients with pituitary adenoma and to investigate the mechanisms involved.
Fifty-one patients (27 females and 24 males) with pituitary adenoma were examined. Nineteen (37.3%) of these patients (13 females and 6 males) had headache preoperatively. Most commonly, the headache was generalized (42.1%); overall headache was more frequent in the anterior half of the head (84.2%). Seventeen (89.5%) patients had bilateral headache. Headache was usually described as head heaviness (57.9%) and continuous (57.9%). Pulsating headache and dull pain were only reported by the female patients and were mostly intermittent. The mean age of patients with headache was younger than that of those without headache. Headache was more prevalent in patients with a prolactin-secreting adenoma (57.1%). There were no correlations between visual disturbances, hypopituitarism, tumor size, or cavernous sinus invasion and headache. Hemorrhagic pituitary adenoma in 4 (57.1%) of 7 patients did not always contribute to headache. The headache was improved after surgery in 14 (73.6%) of the 19 patients. In the male patients who survived postoperatively (5 of 6), headache was improved.     

Cryptic pituitary hemorrhage presenting with headache

We report a case of pituitary hemorrhage and review the literature on that condition. Our patient presented with a sudden bifrontal headache associated with vague transient visual blurring but without nausea or other associated symptoms. After a negative workup at another hospital, including an unremarkable brain computed tomography without contrast, and resolution of headache following treatment with injectable sumatriptan, he was diagnosed with "atypical migraine." The patient's symptoms soon returned, and brain magnetic resonance imaging revealed an enlarged, cystic pituitary gland with a small intraparenchymal hemorrhage.     

垂体腺瘤侵袭性与临床特征相关性分析

目的探讨垂体腺瘤侵袭性与病人临床特征间的相关性。方法从我科1998年5月~2004年9月收治的113例垂体腺瘤病人中筛选临床资料较全的85例,对患者临床特征及肿瘤MR及CT表现进行回顾性分析。结果垂体腺瘤侵袭性强弱与病人性别、肿瘤大小、形态、有无卒中、坏死、囊变及术后尿崩的发生率、肿瘤术后复发率相关。结论侵袭性垂体腺瘤与非侵袭性垂体腺瘤之间并无严格界限。侵袭性强弱与病人的性别、肿瘤大小、形态、有无卒中、坏死、囊变及术后尿崩的发生率、肿瘤术后复发率相关。     

Migrainelike Headache in a Patient With a Hemorrhagic Pituitary Macroadenoma

A 23-year-old woman presented with a 4-day history of a severe migrainelike headache with a normal neurologica examination. The headache resolved after a ketorolac injection, but recurred a few hours later. An MRI scan of the brain showed a hemorrhagic pituitary macroadenoma for which she underwent transsphenoidal removal of the tumor 1 month later. Although uncommon, pituitary hemorrhage with and without apoplexy should be considered in the differential diagnosis of acute headache. Pituitary hemorrhage can be routinely identified on an MRI scan even without pituitary views. However, the pathology can be overlooked and underimaged on a CT scan for acute headache using 10-mm and even 5-mm slices.     

立体定向放射治疗脑垂体瘤344例远期疗效观察

目的评价立体定向放射治疗脑垂体瘤在控制肿瘤生长和改变内分泌方面的长期疗效。方法1998年1月至2004年12月,应用伽玛刀治疗垂体腺瘤398例;344例获得随访,随访期18~72个月,平均46个月;针对不同组织类型肿瘤采用相应治疗剂量,应用45%~55%等剂量曲线覆盖肿瘤至少95%以上;无功能腺瘤边缘治疗剂量10~18 Gy(平均14.6 Gy),中心剂量20~36 Gy(平均28.8 Gy);功能性腺瘤边缘治疗剂量12~35 Gy(平均22.7 Gy),中心剂量24~70 Gy(平均52.9 Gy)。结果肿瘤控制生长率达91.6%,症状改善率达85.2%,激素水平下降或恢复正常达86.0%,无死亡,无严重并发症。结论立体定向放射治疗脑垂体瘤无论是对治疗首选还是对术后残存的肿瘤,其控制生长和改善内分泌的作用均是安全和有效的,治疗后影像学改变和内分泌变化与治疗剂量密切相关。     

个性化健康教育在垂体瘤患者不同治疗阶段的实施及效果

目的探讨个性化的健康教育在垂体瘤患者不同治疗阶段的实施及效果。方法便利抽样法选取2012年1月至2013年2月在海军总医院神经外科治疗的118例患者为研究对象。按其入院时间的先后,将其分为对照组(n=58)和观察组(n=60)。对照组患者按传统方法进行健康教育,观察组患者采用个性化、分阶段的健康教育方法。出院前,比较两组患者对健康教育的满意率,并统计住院期间并发症的发生情况。结果对照组患者对健康教育的满意率为92.0%,而观察组患者的满意率为99.0%,差异有统计学意义(P0.05)。观察组患者的并发症发生率为3.33%,低于对照组的8.62%,差异有统计学意义(P0.05)。结论在垂体瘤患者的不同治疗阶段,开展个性化的健康教育可提高健康教育效果。     

垂体瘤术后并发症17例分析

目的探讨垂体腺瘤术后并发症发生的原因及其治疗方法。方法采用回顾性分析对术后发生多种并发症的17例垂体腺瘤患者的临床资料进行分析。结果17例患者术后出现4例昏迷、高热(23.5%),7例低钠血症(41.2%),2例高钠血症(11.8%),15例尿崩症(88.2%),1例垂体功能减退(5.9%),12例肺部感染(70.6%),7例泌尿系感染(41.2%),3例消化道出血(17.6%)。治愈13例(76.5%),好转1例(5.9%),死亡3例(17.6%)。结论垂体瘤术后可出现多种并发症,影响患者的生存和预后。提高手术操作技巧,术后严密监测生命体征、加强护理、合理使用抗生素等可减少并发症的发生,促进并发症的恢复。     

半乳糖凝集素-3在垂体腺瘤的表达及意义

目的 研究半乳糖凝集素-3(Galectin-3)与垂体腺瘤侵袭性的关系.方法 用免疫组织化学技术S-P法检测Galectin-3在63例垂体腺瘤的表达,并将38例PRL腺瘤分为侵袭组和非侵袭组,分析两组之间的表达差异.结果 (1)Galectin-3在38例PRL腺瘤中有28例表达(73.68%),10例ACTH腺瘤中有4例表达(40.00%),其他类型的垂体腺瘤均未见表达,在正常垂体组织无表达.(2)PRL腺瘤侵袭组与非侵袭组的阳性表达率为92.0%(23/25)和38.46%(5/13),两组之间差异有统计学意义(P<0.01).结论 Galectin-3在不同类型垂体腺瘤有不同的表达,Galectin-3的表达与PRL腺瘤的侵袭性密切相关.     

垂体瘤术后患者生活体验的质性研究

目的探索垂体瘤术后患者真实生活体验。方法对15例垂体瘤术后患者进行深入访谈,现场录音和笔录,并采用现象学分析法分析资料。结果通过阅读、分析、反思、分类和提炼主题,得出3个主题:垂体瘤患者的反应迥然(术后很满意,重新找回自己;术后仍存在不适症状困扰;面对各种异常检验数值的无奈);垂体瘤术后患者存在的压力感受(经济负担重;担心复发;担心生育问题;存在安全隐患;我没你们想象的过得那么好);垂体瘤术后患者不同的压力应对方式和希望水平(充满希望、坦然面对;独自承受、缺少关爱;依从性差;消极应对;绝望崩溃)。结论垂体瘤术后患者在生理、心理、社会等方面存在压力,在研究和关注垂体瘤术后患者康复问题的同时,需要给予患者更好的健康教育和心理疏导、提供有效的社会支持,以期指导患者正确的应对,改善患者的生活质量。     

神经导航显微镜下经鼻蝶垂体瘤切除术的疗效观察

目的：探讨神经导航显微镜下经鼻蝶垂体瘤切除术对患者自体功能相关激素水平及视觉功能的影响。方法：垂体瘤患者87例,根据手术时间分为对照组42例、观察组45例。对照组采用神经内镜经鼻蝶垂体瘤切除术,观察组采用神经导航显微镜下经鼻蝶垂体瘤切除术。随访1月,比较2组手术相关指标、垂体功能相关激素水平、视觉功能、并发症等。结果：观察组的手术时间、住院时间短于对照组,出血量大于对照组（P<0.05或P<0.01）;促甲状腺激素（TSH）、游离三碘甲状腺原氨酸（FT3）、促肾上腺皮质激素（ACTH）、泌乳素（PRL）明显高于对照组,皮质醇（COR）明显低于对照组（均P<0.05）;视野平均缺损（MD）值、视野模式标准差（PSD）低于对照组,视野指数（VFI）高于对照组（P<0.05或P<0.01）;2组脑脊液漏等并发症比较差异无统计学意义（P>0.05）。结论：神经导航显微镜下经鼻蝶垂体瘤切除术有助于促进患者垂体功能相关激素水平恢复,改善视觉功能。     

神经内镜与显微镜经鼻蝶窦入路切除垂体瘤及对激素水平的影响*

目的比较神经内镜下经鼻蝶窦入路垂体瘤切除术与显微镜下垂体瘤切除术的手术效果及对激素水平和临床症状的影响。方法回顾性分析2012年1月-2016年6月在该院经手术切除的211例垂体瘤患者资料。其中,神经内镜下经鼻蝶窦入路垂体瘤切除术112例(A组),显微镜下经鼻蝶窦入路垂体瘤切除术99例(B组),比较两组手术相关指标、出院前激素水平变化及术后24周症状改善情况。结果两组患者肿瘤切除程度不同(Z=2.14,P=0.032),A组达到全切比例明显高于B组(79.5%vs 67.7%,P=0.037);A组手术时间明显长于B组[(93.6±26.7)vs(79.8±20.2)min,t=4.26,P=0.000],A组术后平均住院天数明显少于B组[(7.9±2.5)vs(10.2±4.3)d,t=4.67,P=0.000],A组术后并发症发生率明显低于B组(5.4%vs 14.1%,χ~2=4.73,P=0.030)。两组术后激素水平下降程度不同(Z=2.42,P=0.016),A组出院前激素复常率明显高于B组(82.2%vs 66.7%,χ~2=6.09,P=0.014),出院前A组泌乳素腺瘤、促肾上腺皮质激素腺瘤、生长素腺瘤患者激素下降水平明显高于B组[(43.2±10.5)vs(33.5±9.1)ng/ml、(26.0±8.8)vs(20.2±7.0)pmol/L、(11.0±3.9)vs(8.7±3.2)μg/L,t=3.60、t=2.65、t=2.12,均P0.05]。两组术后24周临床症状缓解比例差异无统计学意义(P0.05)。结论神经内镜下经鼻蝶窦入路垂体瘤切除术较显微镜手术垂体瘤切除效率更高,手术并发症更少,更有助于术后激素水平的复常。     

MRI动态增强扫描在垂体微腺瘤诊断中的价值

目的:观察25例脑垂体微腺瘤患者MRI动态增强扫描在垂体微腺瘤诊断中的价值。方法:25例垂体微腺瘤患者血PRL均>40ng/ml。采用德国Siemens Impact 1.0T超导型磁共振扫描仪,行垂体动态增强扫描时,用对比剂Gd-DTPA(马根维显),其剂量为0.1mmol/kg,采用快速自旋回波序列。结果:常规平扫25例中有15例可见异常信号改变,占60%,而动态增强扫描后22例可见正常垂体腺、漏斗、海绵窦逐一明显强化,微腺瘤则尚未强化仍呈低信号区,形成鲜明对比的图像特征,占88%。平扫垂体一侧饱满或T1、T2未见异常信号者并不干扰此特征的出现。结论:MRI动态增强扫描具有特征性征象,在冠状位上对垂体微腺瘤最具有诊断意义。     

Clusterlike headache as first manifestation of a prolactinoma

We report a case of cluster headache in a patient with a macroprolactinoma. Symptomatic cluster headache was suspected because of an unsatisfactory response to medications that are usually effective in idiopathic cluster headache. The neurological examination was normal. However, magnetic resonance imaging demonstrated a large pituitary tumor. One year after starting treatment with cabergoline, the patient remains asymptomatic. Symptomatic cluster headache should be suspected when the clinical features of the headache are atypical. By inducing vascular mechanisms, the parasellar lesion may have played a role in initiating the cluster headache.     

3D-Slicer软件在神经内镜经鼻蝶入路垂体腺瘤手术中的应用

目的 探讨3D-Slicer软件辅助神经内镜经鼻蝶入路垂体腺瘤手术的疗效与价值。方法 28例垂体腺瘤患者行头颅CT和头颅MRI检查,将影像数据输入3D-Slicer软件,对蝶窦、鞍区骨性结构、垂体腺瘤及颈内动脉、视神经结构进行三维重建,并行术前规划,判断神经血管和肿瘤的空间关系,模拟磨除鞍底的过程,将重建图像与术中图像进行比较,评价两者吻合程度,记录术后并发症和疗效。结果 所有患者的三维重建图像中,蝶窦、鞍区骨性结构、垂体腺瘤及神经血管均可清晰显示,与术中内镜下实际图像高度匹配,能准确识别重要结构,并规划出鞍底骨窗的合适范围。所有患者手术过程顺利,术后均未发生严重并发症。结论 3D-Slicer软件运用于神经内镜下经鼻蝶入路垂体腺瘤手术,有助于术前明确显示蝶窦、蝶鞍、肿瘤与神经血管的空间关系,可帮助提高手术安全性与手术效率。     

生长分化因子-15在垂体腺瘤中的表达及意义

目的探讨生长分化因子(GDF)-15在垂体腺瘤中的表达及意义。方法选择100例垂体腺瘤患者组织标本,根据是否具有侵袭性分为侵袭性垂体腺瘤63例和非垂体腺瘤37例,并选择同期在本院接受体检的健康人员50例作为对照组。比较各组受试者GDF-15的表达,并分析GDF-15和垂体腺瘤侵袭性的相关性。结果泌乳素垂体腺瘤与生长激素垂体腺瘤患者GDF-15均显著高于无功能性垂体腺瘤患者(P0.50);侵袭性垂体腺瘤患者GDF-15水平显著高于非侵袭性组及对照组(P0.05);GDF-15和侵袭性垂体腺瘤呈正相关(r=0.328,P=0.001)。结论在垂体腺瘤患者中,GDF-15的表达较高,且GDF-15水平和垂体瘤侵袭性存在相关性。     

经单鼻孔蝶窦入路切除垂体腺瘤

目的探讨经单鼻孔蝶窦入路切除垂体腺瘤的手术技巧以及术后并发症的处理。方法回顾性分析我科经单鼻孔蝶窦入路手术切除垂体腺瘤32例临床资料,对手术技巧及并发症进行分析、探讨。结果全切除23例,次全切8例,部分切除1例,无死亡病例及严重并发症发生,术后患者症状均有不同程度的改善。结论经单鼻孔蝶窦入路切除垂体腺瘤具有安全、微创、简单、恢复快的特点,对于位于鞍内和大部位于鞍内的垂体腺瘤是一种有效的术式。