PRL性垂体腺瘤术后动态垂体激素观察与MRI结果的相关性分析

目的探讨垂体泌乳素腺瘤切除后血清泌乳素水平与术后MRI结果之间的相关性,以判断PRL腺瘤患者术后有无肿瘤残留及评估预后。方法对18例垂体泌乳素性腺瘤患者的术前及肿瘤切除后泌乳素水平进行动态观察,对肿瘤切除后血清激素水平与术后MRI结果之间的相关性进行统计学分析。结果肿瘤切除前、后血清泌乳素水平具有显著性差异;肿瘤切除后24小时及以后各时点血清泌乳素水平无显著性差异;激素评定方法和MRI评定结果无显著性差异,一致性好。结论垂体泌乳素腺瘤切除术后早期连续动态血清PRL监测结果对判断术后有无肿瘤残留具有重要价值。     

伽玛刀分次治疗垂体泌乳素大腺瘤和巨腺瘤的近期疗效观察

目的　探讨伽玛刀分次治疗垂体泌乳素大腺瘤和巨腺瘤的近期疗效。方法　分别对 2 2例和 11例垂体泌乳素大腺瘤及巨腺瘤患者进行分次伽玛刀治疗及单次治疗 ,观察其治疗前后的临床症状、血清泌乳素 (PRL)水平、肿瘤体积等 ,分析伽玛刀分次治疗垂体泌乳素大腺瘤和巨腺瘤的近期疗效。结果　 2种方法治疗前后瘤体都有所缩小 ,PRL水平下降 ,分次治疗总有效率为 86 4% ,单次治疗总有效率为 45 5 % ,分次治疗对PRL水平的恢复明显优于单次治疗 (P <0 0 1) ;而对肿瘤大小的影响无显著差异 (P >0 0 5 )。结论　伽玛刀分次治疗垂体沁乳素大腺瘤和巨腺瘤是安全有效的治疗方法 ,其近期疗效明显优于伽玛刀单次治疗     

血清PRL水平及肿瘤体积对垂体泌乳素瘤疗效的影响

目的：观察血清泌乳素（prolactin,PRL)水平及瘤体MRI测量对垂体泌乳素瘤（prolactionoma)诊治的价值。方法：回顾分析32例垂体泌乳素瘤的诊断与治疗。全部病例均在初诊和治疗6个月后标记免疫法测定血清PRL水平,并同时做MRI垂体扫描。记录测量值并作统计学处理。结果：（1）内科治疗6个月后血清泌乳素下降至正常有29例,占90．6％,垂体MRI显示瘤体体积缩小21例,占65．6％,（2）大腺瘤患者及血PRL水平大于100ng/L患者疗效较好。结论：血清泌乳素水平测定及MRI垂体扫描均可作为垂体瘤临床疗效判断的观察指标,MRI垂体扫描同时可作为诊断定位指标。     

泌乳素瘤的MRI表现及内分泌特征的临床研究

目的:分析垂体泌乳素瘤的MRI表现与其内分泌特征之间的关系。材料与方法:回顾性分析44例经手术后病理证实为垂体乳素瘤病例的MRI表现特征,并与其术前血清PRL水平进行对比。结果:泌乳素微腺瘤24例,20例微腺瘤体位于垂体侧翼,4例位于垂体中间部。MR平扫T1WI图上,18例呈低信号,6例呈等信号;T2WI图上,17例呈高信号,7例呈等信号。Gd-DTPA增强T1WI图上,所有的病例均呈相对低信号。泌乳素巨腺瘤20例,平扫T1WI图上,13例呈稍低信号,6例呈等信号,1例呈稍高信号;在T2WI上,13例为稍高信号,4例为等信号,4例为高信号。本组巨腺瘤中,肿瘤合并出血、坏死及囊变比例较高,约占35%(7/20)。磁共振增强T1WI图上,巨腺瘤实质部分均匀强化,出血,坏死及囊变部分不强化。微腺瘤组平均大小为7.5±0.5mm,术前血清PRL均值为153.12±82.95ng/ml;巨腺瘤组平均大小为29.5±7.5mm,术前血清PRL均值为295.25±25.67ng/ml。两组瘤体大小与PRL水平均无正相关线性关系(r微腺瘤组=0.3652;r巨腺瘤组=0.3968),但巨腺瘤组血清PRL水平高于微腺瘤组(P<0.01)。结论:垂体泌乳腺瘤MRI表现与其内分泌特征有关,泌乳腺瘤的大小与血清PRL有关,但并不呈线性关系。     

垂体泌乳素腺瘤手术前后内分泌检测结果的对比研究

目的对比研究垂体泌乳素腺瘤手术前后内分泌检测结果。方法统计分析2012年3月至2014年3月该院收治的48例接受垂体泌乳素腺瘤手术患者的临床资料。结果所有患者手术过程中均不需要输血。单鼻孔入路经蝶显微手术时间1.0~2.5h,平均(1.5±0.3)h;经颅手术时间1.6~3.0h,平均(2.5±0.1)h;手术后1d,1、3、6个月患者的雌二醇(E2)、黄体生成素(LH)、孕酮(P)水平均明显高于手术前(P0.05),血清泌乳素(PRL)水平均明显低于手术前(P0.05);手术后1个月患者的促卵泡素(FSH)水平均明显高于手术前(P0.05),但手术前和手术后1d,3、6个月患者的FSH水平之间的差异均无统计学意义(P0.05)。结论在垂体泌乳素腺瘤的治疗中,显微手术切除肿瘤能够有效改善患者的内分泌各项指标,且安全便捷,可以作为临床上主要治疗方法。临床还应该在手术前后对患者的内分泌各项指标进行认真的检测,将其检测值的变化充分利用起来,从而为对患者的治疗取得更好的效果、将患者的复发率降低到最低提供良好的前提条件。     

垂体腺瘤的MRI影像特征

目的:探讨MRI对垂体腺瘤的诊断价值及鉴别诊断。方法:对37例经手术及病理证实的垂体腺瘤,分析其MRI表现。结果:25例微腺瘤中泌乳素腺瘤16例,生长激素腺瘤6例,促肾上腺皮质激素腺瘤2例,促甲状腺激素腺瘤1例。T1WI低信号及稍低信号18例,等信号7例;T2WI呈高信号及稍高信号18例,等信号7例。12例大腺瘤中泌乳素7例,生长激素腺瘤2例,促肾上腺皮质激素腺瘤1例,无功能性腺瘤2例。T1WI呈等信号9例,高信号2例,低信号1例,T2WI高信号10例,等信号2例。结论:MRI能准确反映垂体腺瘤的影像特征,对诊断和手术具有重要指导意义。     

经鼻蝶窦入路行垂体瘤切除术后尿崩症的观察及护理

垂体腺瘤是颅内常见肿瘤之一，是发生于垂体前叶组织的肿瘤，约占颅内肿瘤的10％-12％。根据细胞分泌功能的特点可分为功能型腺瘤，主要有泌乳素（PRL）腺瘤、生长素（GH）腺瘤、促进上腺皮质激素（ACTH）腺瘤等和无功能腺瘤。另外，根据影像检查结果可分为垂体微腺瘤（直径〈1cm），垂体大腺瘤（直径1～3cm），垂体巨腺瘤（直径〉3cm）。治疗方法以手术为主，但术后亦可产生一些并发症，如尿崩症、出血等。其中尿崩症是最常见的并发症，其主要临床表现为尿量的增多，随之引起一系列病理生理变化，若处理不当可引起水电解质紊乱、心肾功能衰竭而危及生命。我科2004年1月～2006年3月对经鼻蝶窦入路行垂体瘤切除术的患者进行了严密的监测和系统的观察及护理。现报告如下。     

巨大垂体腺瘤临床病理分析

目的：总结巨大垂体腺瘤的临床及病理学特征。方法收集2011年1月至2013年12月山西省人民医院显微镜手术治疗的15例巨大垂体腺瘤,并随机选取10例非侵袭性垂体小腺瘤进行临床病理特征分析及免疫组化检测。结果15例巨大垂体腺瘤,发病年龄26～66岁,平均年龄47.7岁,症状持续时间较长,进展缓慢,临床以无功能性腺瘤多见,MRI检查均具有不同程度的侵袭性,免疫亚型以单激素或多激素泌乳素腺瘤多见,增殖细胞核抗原PCNA表达量明显增高,核分裂计数及Ki67增殖指数略高于非侵袭性垂体小腺瘤组。结论巨大垂体腺瘤具有一定程度的侵袭性,PCNA可以作为评价巨大垂体腺瘤侵袭性的一个较为敏感的指标。     

垂体泌乳素测定的临床应用

对２１１例闭经，溢乳患者采用放射免疫分析检测血清中泌乳素（ＰＲＬ），促卵泡激素，促黄体激素，雌二醇及睾酮水平，对高泌乳素血症者加行蝶鞍Ｘ线摄片或ＣＴ检查。结果，ＰＲＬ〈１０００ｍＩＵ／Ｌ者１４５例，ＰＲＬ〉１０００ｍＩＵ／Ｌ者６６例，其中垂体腺瘤５例，可疑垂体微胶瘤４例，非肿瘤性高泌乳素血症５７例，溴隐亭治疗垂体微腺瘤和功能性高泌乳素血症疗效较佳。提示，垂体泌乳素测定对闭经，溢乳的病因检查具有重要     

垂体腺瘤的影像诊断进展

垂体腺瘤（pituitary adenoma）是最常见的垂体原发良性肿瘤,占鞍区肿瘤的90％,起源于垂体前叶,近年来发病率亦有上升趋势。垂体腺瘤可发生于任何年龄,发病高峰在30～50岁,女性多见。随着各种影像检查手段的综合应用,垂体腺瘤的检出率及正确诊断率亦越来越高,近年来,特别是磁共振（magnetic resonance imaging,MRI）成像技术硬件与软件的开发与应用,     

82例垂体泌乳素瘤的CT诊断

目的 探讨冠状位CT增强扫描对垂体泌乳素瘤的诊断价值。方法 82例垂体泌乳素瘤,80例为女性,平均年龄27岁,2例为男性,均有相应临床症状和血泌乳素值(PRL)升高,全部病例行冠状位CT增强扫描。结果 82例中76例(92.7％)为垂体微腺瘤,CT表现为垂体内>3mm低增强区、垂体上缘膨隆、垂体柄偏斜、垂体高度>9mm和鞍底骨质改变,以前三项显示率较高,分别为88.2％、85.5％和59.2％,具有较大诊断意义。结论 垂体泌乳素瘤多见于青年女性,大部分为微腺瘤,本病诊断除临床症状和血PRL值升高外,CT冠状位增强扫描有很大辅助诊断价值。     

Functional role of estrogen in pituitary tumor pathogenesis

Pituitary hyperplasia and lactotroph replication are induced by estrogen. The product of the pituitary tumor transforming gene (PTTG) exhibits in vitro and in vivo transforming activity and induces basic bFGF secretion, thereby modulating pituitary angiogenesis and tumor formation. We demonstrated previously that pituitary pttg is induced by estrogen and bFGF, the latter being expressed in a concordant fashion with pttg in experimental and human pituitary adenomas. We now elucidate the role of estrogen in paracrine regulation of pituitary tumorigenesis by PTTG. Coincident with the circulating rat estradiol surge and maximal pituitary proliferation, pituitary pttg mRNA, bFGF, and VEGF expression increased approximately threefold during proestrus and estrus. Osmotic mini-pump coinfusion of estrogen and antiestrogen abrogated estrogen-induced pituitary pttg expression in vivo, suppressed serum PRL concentrations by 88%, and attenuated prolactin-secreting pituitary tumor growth by 41% in rats. Antiestrogen treatment of primary human pituitary tumor cultures reduced PTTG expression approximately 65%. Pituitary pttg, bFGF, and VEGF are cyclically expressed during the rat estrus cycle, concordantly with estrogen levels. Because anti-estrogens reduced PTTG expression in human pituitary tumors in vitro and suppressed experimental tumor growth in vivo, concomitantly with reduced PRL secretion, these results indicate a role for selective antiestrogens in treating pituitary tumors.     

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.     

Prolactin dynamics and tumour size in the prediction of surgical outcome for prolactinoma

Each of 62 females were studied for a period of between two and 72 months (mean 36 months) following the removal of a prolactinoma by transsphenoidal pituitary surgery. Our aims were to define the relationships between pre- and post-operative features, the operative findings and the functional outcome. Pre-operative serum prolactin (PRL) concentrations correlated with tumour diameter (r = 0.55, p less than 0.001). Following surgery two groups of patients were identified: Group 1, 46 spontaneously and regularly menstruating patients and Group 2, 16 patients with persistent amenorrhoea. The patients in Group 1 had significantly lower pre-operative and post-operative serum (PRL) concentrations (p less than 0.02 and p less than 0.001 respectively) and significantly greater PRL responses to thyrotrophin releasing hormone (TRH) and metoclopramide stimulation after surgery (p less than 0.001). There was not a significant difference in tumour size between the groups. Forty-four (96 per cent) of the patients in Group 1 had normal post-operative serum PRL concentrations within one week of surgery. By comparison (p less than 0.001) only 42 and 20 per cent respectively of Group 1 patients who were tested had normal TRH and metoclopramide evoked PRL secretion following surgery. Return of regular menstruation was associated with cessation of galactorrhoea in 44 patients (96 per cent) and ovulation occurred in 37 of 38 menstruating patients for whom data are available. All patients with normal TRH and metoclopramide stimulation tests menstruated spontaneously. Nevertheless most patients who menstruated did so in spite of retaining suppressed PRL responses. Of 46 patients followed to date whose serum PRL was normal one week after surgery, seven later were found to have an elevation of serum PRL outside the normal range but in only two has this been persistent. We suggest that a single measurement of serum PRL one week following transsphenoidal pituitary surgery for prolactinoma provides a good basis for deciding about the future management of patients who desire menstruation and pregnancy.     

Macroprolactin: what is it and what is its importance?

Monomeric prolactin (PRL) of molecular weight 23 kDa constitutes up to 95% of adult serum PRL. Macroprolactin is a large antigen-antibody complex of molecular weight greater than 100 kDa and constitutes less than 1% of circulating PRL. Thus, in most cases, hyperprolactinaemia is usually a result of high levels of monomeric PRL, which may be due to excess production as with a prolactinoma or due to disinhibition by compression of the pituitary stalk. Nevertheless, it must be noted that macroprolactinaemia may be a cause of hyperprolactinaemia in some individuals, which may have no association with any pathology. The presence of macroprolactin should always be suspected when a patient's clinical history and/or radiological data are incompatible with his/her PRL value. Thus, it may be useful to screen all patients with high sera PRL levels in order to prevent unnecessary investigations into the cause for hyperprolactinaemia. This has recently been facilitated with the advent of simple laboratory tests such as the polyethyleneglycol precipitation method, although gel filtration chromatography remains the gold standard. It is hoped that macroprolactinaemia is included in the differential diagnosis of hyperprolactinaemia.     

Cyclic Cushing's disease in association with a pituitary stone

We have documented what we believe to be the first reported case of a pituitary stone in a patient with pituitary-dependent Cushing's disease. Pituitary stones have been reported exclusively in growth-hormone-producing or prolactin-producing pituitary adenomas. Our patient's ACTH and serum cortisol levels cycled for 15 months and then resolved spontaneously. A CT scan of the head showed calcification of pituitary tissue. Pituitary stones may occur in association with Cushing's disease. We hypothesize that the spontaneous resolution of the cyclic Cushing's disease was due to destruction and ultimate calcification of abnormal pituitary tissue.     

PPAR-gamma receptor ligands: novel therapy for pituitary adenomas

Pituitary tumors cause considerable morbidity due to local invasion, hypopituitarism, or hormone hypersecretion. In many cases, no suitable drug therapies are available, and surgical excision is currently the only effective treatment. We show here abundant expression of nuclear hormone receptor PPAR-gamma in all of 39 human pituitary tumors. PPAR-gamma activating thiazolidinediones (TZDs) rosiglitazone and troglitazone induced G(0)-G(1) cell-cycle arrest and apoptosis in human, rat somatolactotroph, and murine gonadotroph pituitary tumor cells, and suppressed in vitro hormone secretion. In vivo development and growth of murine somatolactotroph and gonadotroph tumors, generated by subcutaneous injection of prolactin-secreting (PRL-secreting) and growth hormone-secreting (GH-secreting) GH3 cells, luteinizing hormone-secreting (LH-secreting) LbetaT2 cells, and alpha-T3 cells, was markedly suppressed in rosiglitazone-treated mice, and serum GH, PRL, and LH levels were attenuated in all treated animals (P < 0.009). These results demonstrate that PPAR-gamma is an important molecular target in pituitary adenoma cells and PPAR-gamma ligands inhibit tumor cell growth and GH, PRL, and LH secretion in vitro and in vivo. TZDs are proposed as novel oral medications for managing pituitary tumors.     

垂体腺瘤MRI诊断与单鼻孔经蝶窦入路切除

目的探讨垂体MRI动态增强扫描对垂体微腺瘤的诊断作用及显微镜辅助单鼻孔-经蝶窦入路切除垂体腺瘤的优点和适应症。方法对怀疑垂体腺瘤的334例患者先行常规MRI平扫,对未见垂体腺瘤的患者再行垂体MRI动态增强扫描。垂体腺瘤手术的患者,全部采用显微神经外科技术经经单鼻孔-蝶入路切除垂体腺瘤。结果334例患者经MR平扫或垂体MRI动态增强扫描后,发现垂体腺瘤326人。其中,MRI常规平扫后发现垂体腺瘤297人,MRI常规平扫后未发现垂体腺瘤的37人经垂体MRI动态增强扫描发现垂体微腺瘤29人。发现垂体腺瘤的326人中,手术316例。手术患者中,252例近全切除,50例大部切除。无手术死亡,术后16例脑脊液鼻漏行腰大池引流治愈,余无手术并发症。结论MRI平扫结合MRI动态增强扫描诊断与单鼻孔-经蝶窦入路切除肿瘤的方法相结合,可取得垂体腺瘤良好的治疗效果。     

Clinical aspects of pituitary incidentalomas

The development of computed tomography(CT) and magnetic resonance imaging (MRI) has resulted in the discovery of unsuspected endocrinologically silent pituitary masses(pituitary incidentalomas). The management of these pituitary incidentalomas is controversial. Some lesions may increase in size, compress optic chiasm while others will remain unchanged in size. Five hundred and six patients with pituitary incidentalomas were obtained by questionnaire from March 1999 to May 2000 under the auspices of the Ministry of Health, Labor and Welfare in Japan. In thirty-three patients with pituitary incidentalomas (13.3%) developed tumor enlargement during the mean follow-up period of 45.5 months. Of 115 estimated non-functioning adenomas, 23(20.0%) tumor increased during mean follow up period of 50.7 months (range 10 to 173 months), while 5(5.4%) of 94 estimated Rathke's cysts increased in size during follow up. Pituitary apoplexy was occurred in one patient of 248 patients (0.4%). Pituitary incidentalomas usually follow a benign course. Transsphenoidal adenectomy is indicated for a solid mass attached to optic chiasma. For other patients, MRI every 6 months for the first 2 years, and then yearly may be recommended.