Massive prolactinoma with galactorrhoea in a prepubertal boy

An 8 year old prepubertal boy presented with raised intracranial pressure, left proptosis and was noted to have galactorrhoea. Cranial computerized tomography revealed a large pituitary tumour infiltrating the cavernous sinus and left orbit. The serum prolactin was 180,600 mU/l (normal value less than 360 mU/l). Prolactinomas are rare in children and galactorrhoea has not previously been reported in a prepubertal child. The management of massive prolactinomas is difficult, but the child presented has made an impressive response to a combination of treatment with surgery, dopamine agonist therapy and radiotherapy.     

Galactorrhoea following surgical procedures to the chest wall: the role of prolactin.

Normal prolactin levels were found in two cases of galactorrhoea following surgical procedures to the chest wall and one was treated successfully with bromocriptine. Studies were then carried out to test the claim that chest-wall injury is one of the common causes of hyperprolactinaemia. Serum prolactin levels were measured before and after thoracotomy in 7 patients, following traumatic rib fractures in 8 patients and after burns to the chest in one patient. No evidence was found to suggest that sustained hyperprolactinaemia follows chest wall surgery or injury, and the role of prolactin in the condition ''chest wall injury'' galactorrhoea is discussed.     

Insulin-dependent diabetes mellitus. Sudden onset following hypophysectomy in an acromegalic patient

A euglycemic woman with acromegaly contracted conspicuous hyperglycemia two hours following transphenoidal hypophysectomy. Insulin therapy was initiated and has by necessity been continued. The development in the immediate postoperative period of blood glucose levels ranging from 300 to 500 mg/dl was totally unexpected, as the levels on the preoperative oral glucose tolerance test were normal. No explanation for this sudden development of hyperglycemia is apparent. Therefore, frequent monitoring of the blood glucose level is necessary in all acromegalic patients following hypophysectomy, even if they are euglycemic prior to surgery.     

溴隐亭在泌乳素腺瘤治疗中的应用

82例泌乳素腺瘤中,直接予溴隐亭药物治疗31例,行经蝶窦手术51例;术后行放疗或药物治疗.对12例复发型或残留者行再手术治疗、药物和放射治疗.平均随访时间为3年.结果微腺瘤手术组与单纯药物组的月经好转率(或男性性功能正常率)分别为78.6％(11/14) 、74.2％(24/31);泌乳素大腺瘤的总术后复发率27.0％(10/37),其中手术加药物与放疗组16.7％(1/6),手术加放疗组22.2％(2/9),手术加药物组25.0％(3/12)和单纯手术组40.0％(4/10);血清泌乳素正常率则分别为100％(6/6)、88.9％(8/9)、91.7％(11/12)和70.0％(7/10).出现药物不良反应4例.认为溴隐亭治疗对泌乳素水平的控制及减少肿瘤复发率有明显疗效,可作为综合治疗中的一种重要手段.     

Colonic stricture in a boy with cystic fibrosis.

Many problems may arise within the gastrointestinal tract of patients with cystic fibrosis. We report a new cause of subacute intestinal obstruction due to a fibrotic stricture of the ascending colon in a child with cystic fibrosis. Treatment was with a right hemicolectomy. There has been no recurrence after nine months follow-up. Recent similar cases suggest that this new pathology is linked to the use of enteric-coated high-strength pancreatin microspheres.     

Foreign body aspiration in a boy with Prader-Willi Syndrome

A five-year-old boy presented with progressive weight gain with effort intolerance and nocturnal symptoms suggesting obstructive sleep apnoea. A clinical diagnosis of Prader-Willi Syndrome was made. As the initial radiography and computed tomography suggested a foreign body, bronchoscopy was done under general anaesthesia and impacted peanuts were removed from the left main bronchus. His symptoms resolved instantly and the patient was asymptomatic at six months follow-up. This report highlights the need to consider foreign body aspiration as a cause for dyspnoea in children with Prader-Willi Syndrome. The report also focuses on the need to adopt strategies that prevent foreign body aspiration and choking in patients with Prader- Willi Syndrome.     

Osteosarcoma in a sixteen-month old boy

We report a case of a sixteen-month old boy with osteosarcoma of the left humerus. To the best of our knowledge this is the youngest case reported in Malaysia. This case illustrates that osteosarcoma although rare does occur in a very young child. The child died six weeks after presentation due to disseminated disease.     

男性泌乳素腺瘤肿瘤生物学行为的研究进展

泌乳素腺瘤占所有垂体神经内分泌肿瘤的32%~66%,大多数泌乳素腺瘤属于良性肿瘤,且女性常见。然而,男性泌乳素腺瘤更具有进袭性,主要表现在术后反复复发、多巴胺激动剂耐药和放疗后肿瘤进展,以及更易发生垂体癌变。本文综述了近年来有关男性泌乳素腺瘤在肿瘤生物学特性方面的文献。文献表明,芳香化酶、SF3B1基因突变、E-钙黏蛋白/β-连环蛋白复合体受损、转化生长因子β1系统、特定基因和不稳定基因组的表达通过不同信号通路直接或间接导致男性泌乳素腺瘤在细胞增殖、上皮间充质转化、血管生成和对多巴胺激动剂抵抗等方面较女性泌乳素腺瘤具有独特的特征。未来还需要更多的研究进一步阐明男性泌乳素腺瘤进袭性的深层机制,将为有效的靶向治疗提供更全面、精准的理论依据。     

泌乳素腺瘤患者免疫功能的变化及其意义

目的探讨泌乳素腺瘤患者细胞免疫及体液免疫功能的变化及其意义。方法检测并比较45例泌乳素腺瘤患者和20例健康人群外周血CD4＋T细胞、CD8＋T细胞、CD3-/CD16＋56＋NK细胞、CD19＋B细胞水平及免疫球蛋白IgAI、gGI、gM和补体C3、C4含量。结果泌乳素腺瘤组与健康对照组比较,外周血CD3＋T细胞、CD4＋T细胞、CD4＋T/CD8＋T细胞比值均下降（P〈0.05或P〈0.01）;CD8＋T细胞水平、CD3-/CD16＋56＋NK细胞、CD19＋B细胞水平与对照组比较无显著性差异（P〉0.05）,且两组免疫球蛋白IgAI、gGI、gM和补体C3、C4含量比较均无明显差异（P〉0.05）。结论泌乳素腺瘤患者细胞免疫功能异常主要表现为辅助T细胞减少,而体液免疫功能影响较小。     

泌乳素瘤50例临床分析

泌乳素瘤是常见的鞍区肿瘤,近年来,随着影像学和内分泌激素检查的普及,泌乳素瘤的发生率明显升高。我们收集了2001—2007年50例泌乳素瘤患者的资料,现报告如下。