Development of pituitary adenoma in women with hyperprolactinaemia: clinical, endocrine, and radiological characteristics

Sixty eight women referred for treatment of hyperprolactinaemia entered a three year follow up study to determine the clinical and endocrine course of the disease and its association with microadenoma of the pituitary. Details recorded before treatment included medical history, gonadotrophin and ovarian hormonal concentrations, and release of prolactin in response to protirelin (thyrotrophin releasing hormone), benserazide, cimetidine, and nomifensine. Sellar tomography was then performed yearly for three years in all women, 54 of them also undergoing computed coronal and sagittal tomography. At baseline evaluation 27 women showed radiological evidence of pituitary adenoma; at the end of the follow up period the number had increased to 41. Amenorrhoea, steady and raised serum prolactin concentrations, a low ratio of luteinising hormone to follicle stimulating hormone, a longer duration of disease, and low serum progesterone concentrations were more common in women with a final diagnosis of pituitary adenoma than in those whose sella remained normal. Tests for release of prolactin had yielded abnormal results from the outset in all 41 women with radiological evidence of pituitary adenoma and in about half of those whose sella had remained radiologically normal. Response to medical treatment (metergoline in 20 patients, bromocriptine in 21) was similar and showed no difference between patients with tumorous and non-tumorous hyperprolactinaemia. These findings suggest that a large proportion of women with hyperprolactinaemia may harbour a prolactin secreting pituitary adenoma which becomes apparent over a relatively short period. Amenorrhoea and steady and raised serum prolactin concentrations are more common in these women. Tests for release of prolactin are of predictive value in identifying women who will develop a pituitary adenoma.     

Ectopic pituitary adenoma presenting as midline nasopharyngeal mass

Introduction  

Ectopic pituitary adenomas are extremely rare. We report a case of ectopic pituitary adenoma in the midline of the nasopharynx. This adenoma probably arose from the pharyngeal remnant of Rathke’s pouch.     

Suprasellar ectopic pituitary adenoma presenting as cranial diabetes insipidus.

We describe the occurrence of a supracellar ectopic pituitary adenoma in a 34 year old woman who presented with cranial diabetes insipidus and subsequently developed galactorrhoea-amenorrhoea. The tumour was demonstrated by both contrast computed tomography scan and magnetic resonance imaging with gadolinium enhancement and was confirmed at operation. Histological examination showed that the suprasellar lesion consisted of a pituitary adenoma while the pituitary biopsy revealed an unrelated pituitary microadenoma embedded in normal pituitary tissues. A review is made of the reported cases of ectopic pituitary adenomas.     

Primary octreotide LAR therapy in GH-secreting pituitary adenoma

A case of a 54-year-old male with active acromegaly and severe aortic stenosis treated primarily with octreotide LAR 20 mg/ IM/month for six months is reported here. His serum growth hormone level declined and was sustained throughout the period of six months (basal GH level 21.8 ng/ml; 1.2 ng/ml six months after therapy; mean+/-SD during six months of therapy 1.36+/-0.34 ng/ml; range 0.9 - 1.9 ng/ml). The post-treatment, postgadolinium, T1 weighted sagittal magnetic resonance images showed disappearance of the growth hormone secreting adenoma. The use of octreotide LAR as primary therapy in active acromegaly is discussed along with a brief review of literature.     

放射治疗在垂体瘤治疗中的地位：附386例分析

本文分析我院自1963年至1986年收治垂体瘤386例治疗情况。计单纯手术117例,单纯放疗97例,手术加放疗者172例。1980年4月以前收治119例(甲组),采用常规开颅手术切除肿瘤,放疗采用钴~(60)或直线加速器照射,1980年4月以后收治267例(乙组)。采用显微外科切除肿瘤,手术加放疗患者,配合直线加速器治疗。患者随防2～23年,甲组有效率为90.7％,乙组有效率为94％,两组结果表明手术配合放疗效果较理想,复发率均比单纯放疗或单纯手术低。作者认为,为减少复发,改善远期效果,垂体瘤手术配合放射治疗仍属必要。     

泌乳素垂体腺瘤的临床特点与诊断治疗

目的探讨泌乳素（PRL）垂体腺瘤的临床特点与诊治。方法回顾性分析手术治疗的45例侵袭性PRL垂体腺瘤和67例非侵袭性PRL垂体腺瘤的临床表现、内分泌学表现和影像学资料及治疗效果。结果大垂体腺瘤侵袭性发生率（50．8％）明显高于小腺瘤和微腺瘤侵袭性发生率（21．1％）,差异有统计学意义（P〈0．01）;侵袭性垂体腺瘤瘤卒中的发生率（24．4％）明显高于非侵袭性垂体腺瘤瘤卒中的发生率（7．5％）,差异有统计学意义（P〈0．05）;侵袭性垂体腺瘤中复发性垂体瘤的发生率（40．0％）明显高于非侵袭性垂体腺瘤瘤复发性垂体瘤的发生率（7．5％）,差异有统计学意义（P〈0．01）;侵袭性垂体腺瘤与非侵袭性垂体腺瘤全切除率分别为42．2％和69．6％．差异有统计学意义（P〈0．01）。结论侵袭性垂体腺瘤的诊断治疗复杂,术后需综合治疗。     

Empty sella developing during thyroxine therapy in a patient with primary hypothyroidism and hyperprolactinaemia.

A 35 year old woman presented with severe primary hypothyroidism and galactorrhea. A very high prolactin level was also detected and computerized tomography scan of the sellar region demonstrated an enlarged pituitary gland associated with contrast enhancement. Replacement therapy with thyroxine corrected both biochemical and clinical abnormalities but empty sella developed during this therapy. It is concluded that empty sella may be related to thyroxine-induced shrinkage of lactotroph and/or thyrotroph cell hyperplasia.     

侵袭性垂体腺瘤的诊断和治疗

侵袭性垂体腺瘤的诊断缺乏特异性的分子标记物,主要依靠影像学,术中所见和术后病理学检查。侵袭性垂体腺瘤的治疗包括手术治疗、药物治疗和放疗。影像学、神经内镜、术中导航的应用和发展、药物治疗和放射治疗水平的提高显著改善了侵袭性垂体腺瘤的治疗效果。侵袭性垂体腺瘤的治疗还需要多学科干预和密切的随访。     

垂体腺瘤复发的诊断和治疗

目的 探讨垂体腺瘤复发的临床特点、诊断及治疗方法。方法 对我院１９９７～１９９９年收治的６７２例垂体肿瘤患者中,３８例复发垂体肿瘤作回顾性临床分析。结果 ３８例复发垂体腺瘤患者均经手术及病理证实,复发时间最短３个月,最长１８年,平均复发时间５．１年。复发临床表现主要为视觉功能障碍、垂体功能障碍和头痛等。ＣＴ和ＭＲＩ表现为类圆形肿物并强化。再次手术经额入路２５例,经蝶入路１３例。３５例有视觉功能障碍     

垂体腺瘤细胞增殖、凋亡与侵袭性生长关系的研究

目的 探讨垂体腺瘤细胞的增殖、凋亡与侵袭性生长的关系。 方法 对37例侵袭性垂体腺瘤及30例非侵袭性垂体腺瘤患者采用免疫组化SP法测定增殖细胞核抗原(PGNA)、B细胞淋巴瘤(Bcl-2)及相关基因(Bax)蛋白产物的表达。 结果 侵袭性垂体腺瘤患者与非侵袭性垂体腺瘤患者比较 ,PCNA、Bcl-2和Bax的表达水平均明显增高(均P<0.05)。结论 垂体腺瘤的侵袭性生长与PCNA、Bcl-2和Bax的异常表达有关 ,是肿瘤细胞不断增殖和凋亡抑制的结果     

经鼻蝶窦入路垂体腺瘤切除术中脑脊液鼻漏的常见原因及分级修补

脑脊液鼻漏是经鼻蝶窦入路垂体腺瘤切除术后的常见并发症.本研究回顾性总结了第二军医大学长征医院神经外科2009年1月至2014年12月收治的550例在显微镜下行经鼻蝶窦入路垂体腺瘤切除术中出现脑脊液鼻漏的65例患者资料,旨在分析显微镜下经鼻蝶窦入路垂体腺瘤切除术中出现脑脊液鼻漏的原因,并阐明分级修补在处理脑脊液鼻漏中的重要作用.     

垂体柄与垂体腺瘤显微解剖关系的临床观察

目的 观察垂体柄与肿瘤的解剖关系。以利术中保护垂体柄免受损伤。方法 在鞍膈平面,以鞍结节与鞍背两者中点的连线为标准,判断垂体柄的侧别位置,再将鞍膈平面视做时钟面板,进而判断垂体柄 的时钟位。结果 71例观察中,垂体柄居左侧17例,右侧41例,后中位13例。其中46例以时钟位判断,5时位13例,6时位11例,7时位7例,4时位5例,3时位4例,2、8及11时钟位各为2例。结论 垂体柄的位置与肿瘤在鞍内的生长方向有关,与向鞍上扩展无关,垂体柄可作为寻找正常垂体组织的标志。     

生长激素型垂体腺瘤临床诊疗进展

生长激素型腺瘤是垂体瘤中常见类型,目前认为其发病与外部环境相关,主要临床表现为内分泌症状和占位效应,以影像学及垂体激素变化作为诊断标准,治疗上以手术为主,辅助治疗包括药物和放射治疗等.但是生长激素型腺瘤发现时体积大,手术全切困难.随着发病机制研究的深入及对以往治疗方式的革新,综合性个体化治疗方案得到临床医师认可.本文针对生长激素型垂体瘤的诊疗进展进行综述.     

原发性甲状腺功能减低症与垂体腺瘤的鉴别诊断

目的探讨原发性甲状腺功能减低致垂体增生的临床特点和诊治方法,避免误诊。方法9例患者各经X线平片、CT、MRI等影像检查发现鞍内鞍上占位性病变,但因影像学及临床特点不典型,经内分泌检查、骨龄检查等确诊为原发性甲状腺功能减低导致垂体增生,遂采用激素替代治疗。结果9例患者均口服甲状腺片治疗,随访4~18个月,内分泌检查除TSH仍高于正常,其余均恢复正常,症状均有不同程度减轻,其中2例患者复查MRI发现病变明显缩小。结论原发甲状腺功能减低,易误诊为垂体腺瘤,应进行内分泌检查、骨龄检查等明确诊断,治疗采用激素替代治疗。     

垂体腺瘤与信号传导机制异常

垂体腺瘤是颅内最常见的肿瘤之一,近年来多种因素被证实与垂体腺瘤的发生、发展有关。垂体（瘤）旁分泌因子以及外周循环靶腺激素信号传导通路功能失调,能够促进相应细胞增殖,进而发展为肿瘤。     

Hyperostosis frontalis interna, acromegaly and hyperprolactinaemia

The association between hyperostosis frontalis interna (HFI), acromegaly and hyperprolactinaemia was investigated. Thirty six acromegalic patients, of whom 19 had hyperprolactinaemia, were compared with 36 randomly-selected, age-sex matched controls. There was a higher prevalence of HFI in the skull X-rays of the acromegalic cohort (P = 0.0002) when compared to the control group. This difference was apparent in both men (P = 0.01) and women (P = 0.01). Acromegalic patients with hyperprolactinaemia also expressed HFI in a higher proportion of individuals than the control group (P = 0.0001). Intra- and interobserver variability was assessed and concordance with 100% and 97% in the moderate and severe HFI sub-groups. The following sub-group analysis was undertaken: acromegalics and those acromegalics with hyperprolactinaemia were compared with the controls and a highly significant distinction was confirmed (P = 0.0007 and P = 0.00001 respectively). A relationship between HFI severity and the patient's age was noted in both male and female acromegalics. Also, the severity of HFI appeared related to disease duration in female acromegalics. The cause of HFI remains unknown but appears to be strongly associated with acromegaly, particularly in the presence of co-existent hyperprolactinaemia. The association may have symptomatic significance and the presence of HFI should be confirmed or refuted in all patients with acromegaly.     

经鼻蝶显微镜与神经内镜垂体瘤切除术治疗垂体瘤疗效比较

目的:探讨经鼻蝶显微镜与神经内镜垂体瘤切除术治疗垂体瘤的效果。方法:收录垂体瘤患者90例,均行经鼻蝶入路垂体瘤切除术,根据手术方式不同分为神经内镜组(n=49)和显微镜组(n=41)。比较两组患者围术期指标(术中出血量、手术时间、住院时间)、肿瘤切除、复发情况、术后并发症发生率等差异性,观察手术前后嗅觉功能(嗅觉识别阈值)、视觉功能[视野平均缺损(MD)、模式标准差(PSD)、加权视野指数(VFI)]、激素水平[泌乳素(PRL)、生长激素(GH)、促肾上腺皮质激素(ACTH)]变化情况。结果:神经内镜组患者术中出血量少于显微镜组,手术时间、住院时间均短于显微镜组(P<0.05),肿瘤全切率高于显微镜组,术后并发症发生率和术后1年复发率低于显微镜组(P<0.05);术后3周,两组患者嗅觉识别阈值均较术前升高,且显微镜组高于神经内镜组(P<0.05),MD、PSD和血清PRL则较术前降低,VFI则较术前升高,且神经内镜组改善程度高于显微镜组(P<0.05);术后3周,两组患者血清GH、ACTH水平均较术前降低(P<0.05),但组间比较差异无统计学意义(P>0.05)。结论:与经鼻蝶显微镜垂体瘤切除术比较,神经内镜下手术切除垂体瘤效果更佳,并发症和复发情况更少见,且手术创伤小,节省手术时间和住院时间,更有利于嗅觉、视觉功能和激素水平恢复正常。     

扩大额下硬膜内入路显微手术切除巨大垂体腺瘤术中垂体柄和垂体的保护

目的总结巨大型垂体腺瘤手术中对垂体柄及垂体的辨识和保护.方法自1998年4月～2002年10月,采用扩大额下硬膜内入路显微手术治疗76例巨大型垂体腺瘤,术中仔细辨识垂体柄及垂体并予保留.结果肿瘤全切63例(83%),54例(71%)垂体柄及垂体得到辨认和保留.术后尿崩发生率为61%,39例(51%)出现血钠紊乱,大部分在1周内恢复.功能性腺瘤术后激素水平明显下降或恢复正常.结论扩大额下硬膜内入路可提高巨大垂体腺瘤的全切率,有利于术中辨识和保留垂体柄及垂体,对垂体柄位置、形态及肿瘤的切除范围的认识和理解,仔细耐心的手术操作是提高垂体柄及垂体保留率的关键.