人垂体生长激素腺瘤临床生化特征分析

目的 研究人垂体生长激素（GH）腺瘤临床生化特征及肿瘤Gsp癌基因表达、激素分泌、细胞增殖水平及侵袭性之间的相互关系。方法 垂体GH腺瘤43例，对其中17例分别提取DNA，经多聚酶链反应（PCR）扩增和基因直接序列分析法检测Gsp癌基因的表达；以^125I-VolR DNA聚合酶活性测量法，检测43例患血清DNA聚合酶活性以间接评价肿瘤组织增生活性；用放射免疫法测定患血清GH分泌水平。结果 Gsp癌基因阴性和阳性患在肿瘤大小、GH水平及侵袭性上均无显性差异。侵袭性垂体腺瘤DNA聚合酶活性比非侵袭性垂体腺瘤患高，在统计学上有显性差异（P＜0．05）。结论 侵袭性垂体腺瘤的增殖活性和GH水平明显增高。DNA聚合酶活性和GH水平可作为判断垂体腺瘤侵袭性的有用参考指标。     

垂体生长激素腺瘤合并睡眠呼吸暂停综合征的治疗

阻塞性睡眠呼吸暂停综合征 (ＯＳＡＳ)是垂体生长激素 (ＧＨ)腺瘤所致肢端肥大症的一个较严重的并发症。 1991年 1月至 1999年 3月 ,7例垂体ＧＨ腺瘤合并严重ＯＳＡＳ的患者 ,因上气道梗阻在围手术期行气管切开术 ,效果良好 ,报道如下。临床资料与方法　　 1.一般资料 :男 5例 ,女 2例。年龄 38～ 6 1岁 ,平均 4 6岁。肢端肥大为主要症状者 6例 ,打鼾为主要症状者 1例。病程 5～ 15年 ,平均病程8 9年。2 .临床表现 :7例均有典型肢端肥大症 ,表现为面容改变、口唇增厚 ,颧骨增高 ,鼻头变大 ,声音变粗 ,皮肤粗糙等症状 ,同时合并打鼾、憋醒、…     

垂体生长激素腺瘤的研究及治疗进展

垂体腺瘤是发生在垂体前叶的良性肿瘤,也是颅内常见的肿瘤之一。近年来,随着神经影像学、内分泌和神经病理诊断学的不断提高,对于垂体生长激素腺瘤的诊断日趋完善,为早期治疗提供了保障。长期以来,手术一直是垂体生长激素腺瘤的首选治疗方法。近年来,随着对垂体生长激素腺瘤治疗研究的深入,药物及立体定向放射治疗（X-刀,γ-刀）等治疗手段已有了长足的进步,出现了一些新的治疗方法。     

伽玛刀治疗生长激素垂体腺瘤14例报告

伽玛刀治疗垂体瘤后,经长期随访视神经损害是一个引起注意的问题,严重者可失明。此问题应予重视。     

生长激素垂体腺瘤合并颅内动脉瘤1例

1病历摘要（图1）男,因颜面及四肢末端肥大5年,突发剧烈头痛10h入院。既往史：诊断垂体腺瘤5年未治疗;高血压病史3年,最高达170／110mmHg;     

垂体生长激素腺瘤的诊断与治疗

作为一种古老的疾病，垂体生长激素腺瘤导致的肢端肥大症是学最早了解但又不断研究、不断认识的一种垂体疾病。对该病的每一次深入认识都促进了诊断和治疗方法的改进与发展。     

垂体生长激素腺瘤的临床和病理特征

目的探讨垂体生长激素（GH）腺瘤患者的临床及病理学特征。方法回顾性分析92例垂体GH腺瘤患者的临床资料,均采用经鼻蝶手术治疗。结果本组患者均有典型肢端肥大症状,但只有20例出现其他内分泌症状;共有微腺瘤20例,大腺瘤72例;侵袭性腺瘤19例,非侵袭性73例;术后免疫组织病理学结果示,GH（＋）15例,GH（＋）和泌乳素（＋）38例,GH（＋）和促肾上腺皮质激素（＋）2例,GH（＋）和促卵泡激素（＋）1例,GH（＋）和促黄体激素（＋）1例;包括GH在内的三种及以上激素（＋）35例。术后1周总缓解率为55．4％（51／92）。单纯GH（＋）腺瘤缓解率为66．7％（10／15）,伴其它激素阳性腺瘤缓解率为53．2％（41／77）,两者无统计学差异（P〉0．05）。73例患者术后随访3～52个月,平均30．3个月,肢端肥大症状、月经不调、溢乳、性欲减退和甲状腺功能异常缓解率分别为86．3％（63／73）、71．4％（5／7）、66．7％（4／6）、33．3％（2／6）和42．9％（3／7）。结论多数垂体GH腺瘤组织病理学表现为多激素阳性腺瘤,但是仅有少数患者表现出除肢端肥大症外的其它内分泌症状。     

垂体生长激素腺瘤伽玛刀治疗的预后及相关因素分析

目的评估立体定向伽玛刀对垂体生长激素腺瘤的治疗效果,并分析预后的相关影响因素。方法回顾性分析垂体生长激素腺瘤应用伽玛刀治疗病例90例,统计分析治疗效果及其与服用生长抑素类药物、边缘剂量、术前生长激素（GH）水平、肿瘤体积大小之间的关系。结果所有病例平均随访51．5个月,生长激素水平恢复正常者46例,治愈率51．1％;生长激素〈5．0μg/L者78例,有效控制率86．7％;84例患者肿瘤缩小明显,有效控制率为93．3％;13例（14．4％）出现垂体功能低下。结论伽玛刀是一种治疗垂体生长激素腺瘤的有效方法;服用生长抑素类药物、术前GH水平、边缘剂量是预后的明显影响因素;肿瘤体积与疗效没有显著的相关性。     

生长激素型垂体腺瘤伽玛刀治疗的疗效分析

目的 评价leksell伽玛(γ)刀治疗生长激素型垂体腺瘤的疗效.方法 对我院自2005年1月至2008年3月应用伽玛刀治疗41例生长激素型垂体腺瘤患者进行回顾性分析,肿瘤直径4～38.6mm,平均15.2mm.采用1.5T磁共振定位,Ganuna-Plan计划系统规划,等剂量曲线16%～60%,治疗周边剂量9.95～35 Gy,中心剂量31.25～70 Gy.结果 33例获随访,30例(90.9%)患者临床症状改善,16例(48.4%)患者的血清生长激素(GH)值降到正常水平,12例(36.3%)患者GH值下降,4例(12.1%)患者GH值无变化.24例(72.7%)患者肿瘤缩小,9例(27.2%)患者肿瘤无改变.结论 γ刀治疗在控制生长激素型垂体腺瘤生长和改善内分泌症状是安全有效的,是GH微腺瘤首选治疗方法;对肿瘤术后残存或复发,尤其是侵袭海绵窦的患者,γ刀是最好的补充治疗.     

Octreotide治疗垂体生长激素腺瘤的体外分子学研究

本文采用PCR和直接序列分析以及原代细胞培养方法研究了32例垂体生长激素(GH)腺瘤的生化特征,发现21例gsp癌基因阴性肿瘤中大多对Octreotide无反应,而11例gsp癌基因阳性肿瘤中就有9例对Octreotide敏感。推测其机理可能与Octreotide通过GH释放抑制因子受体,进而GTP调节蛋白而负反馈调节腺苷酸环化酶活性所致。提示gsp癌基因可作为评价GH释放抑制因子类似物治疗GH腺瘤反应性的分子生物学指标。     

Predicting Arachnoid Membrane Descent in the Chiasmatic Cistern in the Treatment of Pituitary Macroadenoma

ObjectivePreoperative prediction of the arachnoid membrane descent in pituitary surgery is useful for achieving gross total removal and avoiding cerebrospinal fluid leakage resulting from tearing of the arachnoid membrane in the chiasmatic cistern. In this study, we analyzed the patterns of arachnoid membrane descent during or after pituitary tumor surgery and identified the factors related to this descent. MethodsAnalysis was restricted to pituitary macroadenomas not extending into the third ventricle or over the internal carotid artery. To minimize confounding factors, patients who underwent revision surgery, those who had a torn arachnoid during operation or small medial diaphragma sellae (DS) opening, and subtotal resections were excluded. We enrolled 41 consecutive patients in this retrospective analysis. The degree of arachnoid descent was categorized using intraoperative videos. Preoperative magnetic resonance findings, including tumor height, suprasellar extension, and variables including DS area and medial opening size, tumor composition, and displacement of the pituitary stalk and gland were evaluated to determine their correlations with arachnoid membrane descent. ResultsArachnoid membrane descent was significantly correlated with DS area and medial opening size. Based on T2-weighted images (T2WI) magnetic resonance (MR) images, tumor composition was significantly associated with arachnoid membrane descent. Other factors were not significantly correlated with arachnoid membrane descent. ConclusionT2WI of tumor composition and preoperative MR imaging of DS area and medial opening provided valuable information regarding arachnoid membrane descent. These parameters may serve as fundamental measures to facilitate complete resection of pituitary macroadenomas.     

垂体腺瘤的显微外科治疗

目的探讨外科治疗垂体腺瘤显微手术方法的选择。方法对CT或MRI证实的65例垂体腺瘤，采用经蝶入路或经翼点入路两种手术方法，在显微镜下切除肿瘤。结果经蝶手术44例，全切除29例，次全切除15例；无1例死亡。经翼点入路显微手术21例，全切除13例，次全切5例，部分切除3例；死亡1例(死于多器官功能衰竭)。结论采用显微外科技术，针对肿瘤的特点选择不同的手术入路是提高垂体腺瘤全切率、降低死亡率的关键。     

Growth hormone-producing pituitary adenoma with giant secretory granules

Summary Unusually large, oval and pleomorphic secretory granules were noted by electron microscopy in an acidophilic adenoma of the pituitary. The tumor, which was removed by surgery from a 42-year-old woman with elevated blood growth hormone levels and the clinical features of acromegaly, was found to contain growth hormone by the immunoperoxidase technique. This ultrastructural abnormality of secretory granules was not reported so far and was not seen among the 58 cases of growth hormone-producing adenomas investigated in our laboratory.The present case clearly shows that the cytogenesis and cellular composition of pituitary adenomas cannot be determined by solely examining the size and shape of secretory granules.     

Pituitary growth hormone cell adenoma with cytoplasmic tubular aggregates in the capillary endothelium

Summary Electron microscopy revealed the presence of cytoplasmic tubular aggregates in the capillary endothelium of a sparsely granulated growth hormone cell adenoma removed surgically from a 25-year-old female patient with acromegaly. To our knowledge, this is the second publication describing these structures in hypophysial growth hormone cell adenomas.     

Clinical Outcome of Cranial Neuropathy in Patients with Pituitary Apoplexy

Objective

Pituitary apoplexy (PA) is described as a clinical syndrome characterized by sudden headache, vomiting, visual impairment, and meningismus caused by rapid enlargement of a pituitary adenoma. We retrospectively analyzed the clinical presentation and surgical outcome in PA presenting with cranial neuropathy.

Methods

Twelve cases (3.3%) of PA were retrospectively reviewed among 359 patients diagnosed with pituitary adenoma. The study included 6 males and 6 females. Mean age of patients was 49.0 years, with a range of 16 to 74 years. Follow-up duration ranged from 3 to 20 months, with an average of 12 months. All patients were submitted to surgery, using the transsphenoidal approach (TSA).

Results

Symptoms included abrupt headache (11/12), decreased visual acuity (12/12), visual field defect (11/12), and cranial nerve palsy of the third (5/12) and sixth (2/12). Mean height of the mass was 29.0 mm (range 15-46). Duration between the ictus and operation ranged from 1 to 15 days (mean 7.0). The symptom duration before operation and the recovery period of cranial neuropathy correlated significantly (p = 0.0286). TSA resulted in improvement of decreased visual acuity in 91.6%, visual field defect in 54.5%, and cranial neuropathy in 100% at 3 months after surgery.

Conclusion

PA is a rare event, complicating 3.3% in our series. Even in blindness following pituitary apoplexy cases, improvement of cranial neuropathy is possible if adequate management is initiated in time. Surgical decompression must be considered as soon as possible in cases with severe visual impairment or cranial neuropathy.     

垂体腺瘤卒中的观察与护理对策

目的探讨垂体腺瘤卒中的临床观察和护理要点。方法对生长方向不同的垂体腺瘤所表现的不同临床表现进行严密细致的观察术前进行针对性的心理护理和术前准备,术后严密监测生命体征,并加强对垂体前叶功能不全尿崩症脑脊液漏,、、等并发症的观察与护理结果。16例患者全部治愈出院。结论及时的观察和细致的护理是垂体腺瘤卒中患者恢复的重要措施之一。     

经鼻蝶入路显微手术治疗垂体卒中的临床分析

目的总结55例垂体卒中患者的临床表现特征，分析经鼻蝶入路显微手术的疗效。方法回顾性分析经鼻蝶入路显微手术治疗的55例垂体卒中患者的临床和影像学资料。结果本组55例垂体腺瘤中，48例全切除，7例次全切，肿瘤全切率为87．3％。51例视力障碍、视野缺损的患者中46例术后恢复正常（90．2％），5例恢复欠佳；32例伴有内分泌症状的患者中29例明显缓解（90．6％），3例无明显变化。术后一过性尿崩症7例，脑脊液漏5例。无死亡病例5例。结论根据突发头痛及视路症状等相关症状、体征下并结合影像学检查一般可确诊垂体卒中；经鼻蝶入路显微手术和／或内窥镜手术可做为治疗垂体卒中的首选方法。     

Surgical Results of Growth Hormone-Secreting Pituitary Adenoma

Objective

We retrospectively analyzed the surgical outcomes of 42 patients with growth hormone (GH)-secreting pituitary adenoma to evaluate the clinical manifestations and to determine which preoperative factors that significantly influence the remission.

Methods

Forty-two patients with GH-secreting pituitary adenoma underwent transsphenoidal surgery (TSS) between 1995 and 2007. The patient group included 23 women and 19 men, with a mean age of 40.2 (range 13-61) years, and a mean follow-up duration of 49.4 (range 3-178) months after the operation. For comparable radiological criteria, we classified parasellar growth into five grades according to the Knosp classification. We analyzed the surgical results of the patients according to the most recent stringent criteria for cure.

Results

The overall rate of endocrinological remission in the group of 42 patients after primary TSS was 64% (26 of 42). The remission rate was 67% (8 of 12) for microadenoma and 60% (18 of 30) for macroadenoma. The remission rate was 30% (3 of 10) for the group with cavernous sinus invasion and 72% (23 of 32) for the group with intact cavernous sinus. Cavernous sinus invasion in Knosp grade III and IV was significantly correlated with the remission rate. There was a significant relationship between preoperative mean GH concentration and early postoperative outcome, with most patients in remission having a lower preoperative GH concentration.

Conclusion

TSS is thought to be an effective primary treatment for GH-secreting pituitary adenomas according to the most recent criteria of cure. Because the remission rate in cases with cavernous sinus invasion is very low, early detection of the tumor before it extends into the cavernous sinus and a long-term endocrinological and radiological follow-up are necessary in order to improve the remission rate of acromegaly.     

经鼻蝶入路手术治疗GH、ACTH型垂体腺瘤的临床研究

显微镜下经鼻蝶入路切除垂体腺瘤的手术已应用于临床几十年.1992年Jankowski等[1]将内镜技术引入经鼻蝶入路的鞍区占位性病变的手术治疗中,并逐渐成为垂体腺瘤切除术的主要手术方式.