不同垂体瘤对男性垂体-性腺轴影响的比较分析

 目的  分析比较泌乳素瘤、生长激素瘤和无功能腺瘤对男性患者垂体-性腺轴的影响。方法  选取2009年1月至2013年12月在复旦大学附属上海市第五人民医院手术治疗的男性垂体瘤患者291例,根据临床表现和术后病理结果分为3组:A组为泌乳素瘤组,60例;B组为生长激素瘤组,54例;C组为无功能腺瘤组,177例。对比分析3组患者年龄、瘤体大小、血清睾酮(testosterone,T)、泌乳素(prolactin,PRL)、黄体生成素(luteinizing hormone,LH)和卵泡刺激素(follicle stimulating hormone,FSH)等激素水平。结果  患者平均年龄为(48.0±14.2)岁,大腺瘤(瘤体最大径≥10 mm)占96%,T水平低下者占68%,高PRL血症者占62%,LH和FSH低下者各占15%和5%,且患者的LH水平为正常范围内的低值。A组血清PRL水平及重度高PRL血症的比例明显高于后两组(P均<0.05),B组和C组间比较差异无统计学意义(P=0.10,P=0.30)。FSH、LH和T水平由低至高依次为A组、B组和C组,而且A组与B、C组间比较差异有统计学意义(P均<0.05);尽管后两组间的LH水平比较差异无统计学意义(P=0.54),但B组的T水平明显低于C组(P=0.03)。 结论  泌乳素瘤对男性垂体-性腺轴的影响明显大于生长激素瘤和无功能腺瘤,而且三者对LH的影响均大于FSH。生长激素瘤可能还有其他机制导致T水平低下。

Comparison of the influence of different pituitary adenomas on male pituitary-gonadal axis

Objective  To compare the influence of prolactinoma,somatotroph adenoma and nonfunctioning adenoma on male pituitary-gonadal axis.Methods  We included 291 male patients with pituitary adenomas from Jan.,2009 to Dec.,2013.These patients were divided into 3 groups according to symptoms and immunohistochemical analysis results:prolactinoma (A,n=60),somatotroph adenoma (B,n=54),nonfunctioning adenoma (C,n=177).They were compared in terms of age,maximal tumor diameter,serum testosterone (T),prolactin (PRL) ,luteinizing hormone (LH) and follicle stimulating hormone (FSH).Results  The mean age of patient was (48.0±14.2) years.The prevalence of macroadenoma (maximum diameter≥10 mm),low T level,hyperprolactinemia,LH  deficiency and FSH deficiency was 96%,68%,62%,15% and 5%,respectively.The patients had low normal levels of LH.In group A,the serum PRL level and the incidence of severe hyperprolactinemia (SHPRL) were higher than those in group B and group C.No statistical difference in serum PRL level was detected between group B and C.The serum FSH,LH and T levels in group A were significantly lower than those in group B and C.Though the serum LH level in group B and C was similar,while the serum T level in group B was significantly lower than that in group C.Conclusions  The influence of prolactinoma on male pituitary gonadal axis is significantly greater than that of somatotroph adenoma and nonfunctioning adenoma,and all of them show greater effects on LH than on FSH.There may be other mechanisms underlying the pathogenesis of low T level in patients with somatotroph adenoma.