溴隐亭治疗侵袭性巨大泌乳素腺瘤的长期随访结果

目的　观察溴隐亭治疗侵袭性巨大泌乳素腺瘤的长期随访结果。方法　纳入侵袭性巨大泌乳素腺瘤 (IGPs)的标准是:⑴肿瘤直径 4cm以上,侵袭海绵窦或邻近其他结构;⑵血浆PRL>200ng/ml;⑶高泌乳素分泌或占位效应引起的临床症状。符合标准者 20例,其中 6例为术后给以溴隐亭治疗,其余 14例首发溴隐亭治疗。11例配合放疗。结果　所有患者临床症状均得到不同程度改善。在平均随访的 37 3个月内肿瘤体积平均缩小 93 3%, 11例肿瘤在MRI上消失。视力下降者除 1例外其余均获得改善(13 /14)。PRL水平控制正常者 8例,大于 200ng/ml者 7例。服药过程中出现脑脊液漏 1例,行经蝶修补。本组在治疗过程中无肿瘤卒中及耐药现象发生。结论　溴隐亭为侵袭性巨大泌乳素腺瘤的首选治疗,能在较短的时间内有效缩小肿瘤体积和控制PRL水平。部分患者服药后肿瘤消失,另一部分患者肿瘤局限后给以立体定向放射外科治疗,从而避免手术风险和手术费用。溴隐亭对控制PRL和缩小肿瘤体积不是同等敏感的。放疗的选择宜慎重。     

手术治疗男性垂体泌乳素腺瘤73例临床分析

目的分析男性垂体泌乳素腺瘤的临床特点,探讨其综合治疗方法。方法回顾性分析73例经手术治疗男性泌乳素腺瘤病人的临床资料。根据血清泌乳素水平,分为泌乳素≥200 ng/ml组(n=59)及泌乳素<200 ng/ml组(n=14),分析两组的临床和病理特点。结果泌乳素≥200 ng/ml组病人的性功能障碍发生率明显高于泌乳素<200 ng/ml组(P<0.05)。泌乳素与肿瘤平均直径具有相关性(r=0.747,P<0.01)。肿瘤全切37例,大部切除36例。术后病理证实均为垂体泌乳素腺瘤,其中55例为侵袭性腺瘤。术后性功能恢复正常者29例,视力、视野改善者31例。术后辅助药物治疗58例。随访65例,时间36个月,复发11例。结论男性泌乳素腺瘤多呈侵袭性生长,肿瘤大小与泌乳素水平呈正相关。对于压迫症状较重、肿瘤囊变、肿瘤卒中的男性病人,手术联合药物综合治疗是合理选择。     

高泌乳素垂体腺瘤对体重的影响

肥胖是高泌乳素(prolactin,PRL)垂体腺瘤患者的症状之一。本研究将探讨高PRL水平与体重之间的关系。1材料和方法选取1999年至2001年间北京天坛医院神经外科六病房治疗的PRL垂体腺瘤患者,并分为三组:高PRL腺瘤(血清PRL>200ng/ml,48例)组,中PRL腺瘤(血清PRL101～200ng/ml,18例)组,低PRL腺瘤(血清PRL24～100ng/ml,54例)组,患者经过手术、药物和放疗等系统治疗,术前PRL>100ng/ml者,治疗后<100ng/ml;术前PRL在24～100ng/ml者,治疗后在正常范围(PRL<24ng/ml)。对照组:无功能垂体腺瘤(血清PRL<24ng/ml)。比较各组治疗前后患者的体…     

男性垂体泌乳素腺瘤的诊断与治疗

目的 分析总结男性垂体泌乳素腺瘤的诊断和治疗特点方法 对10年间23例男性垂体泌乳素腺瘤患者的临床表现和肿瘤的病理学、内分泌学、影像学及治疗特点进行分析。结果 患者平均年龄38.7岁。临床表现以性功能、视力视野障碍多见。患者平均血清泌乳素水平为2705.22+-　　3.85ng/ml.肿瘤平均高度为30.41+-11.86mm,78%的肿瘤呈侵袭性生长或向鞍上.鞍旁不规则生长。经手术及药物治疗后,患者泌乳素降至641．54+-15.21ng/ml(p〈0.001);18例性功能障碍患者8例改善;13例视力下降的患者11例视力恢复正常或有不同程度改善;12例视野缺损的患者10例视野恢复正常或改善。结论 男性泌乳素腺瘤患者具有年龄高、肿瘤大且多侵袭性生长、泌乳素水平高等特点。单一疗法难以取得满意效果,应结合病人具体情况采用综合治疗。     

雌激素受体及多巴胺受体在泌乳素腺瘤的表达

目的研究雌激素受体(ESR)及其亚型mRNA、多巴胺受体(D2R)及其亚型mRNA在泌乳素腺瘤中的表达。方法应用逆转录酶聚合酶链式反应(RT-PCR)测定30例泌乳素腺瘤标本ESR1mRNA、ESR2mRNA、第五外显子缺失的1型雌激素受体(△5-Del-ESRl mRNA)及D2RmRNA的表达,研究其表达水平与患者性别、肿瘤体积、侵袭性及泌乳素(PRL)水平的关系。结果男性和绝经后女性患者肿瘤ESR1 mRNA表达高于育龄女性患者;侵袭性泌乳素腺瘤高于非侵袭性肿瘤;PRL≥1 000 ng/ml的患者△5-Del-ESRl mRNA表达水平较PRL1 000 ng/ml的患者明显增高。D2RmRNA异构体的表达水平与泌乳素腺瘤生物学行为有关系,D2SmRNA的表达水平在侵袭性与非侵袭性泌乳素腺瘤中存在显著差异,D2SmRNA在侵袭性泌乳素腺瘤中呈低水平表达。结论 ESR1及其亚型△5-Del-ESRl mRNA、D2R及其亚型mRNA表达与泌乳素腺瘤PRL分泌及肿瘤侵袭有关。     

男性巨大垂体泌乳素腺瘤的临床特征及手术治疗

目的 探讨男性巨大垂体泌乳素（PRL）腺瘤的临床特征及手术治疗效果。方法 回顾性分析2018年7月~2019年7月手术治疗的8例男性巨大垂体PRL腺瘤的临床资料。结果 术前血清PRL水平在50.8~9 852 ng/ml,平均3 505.6 ng/ml。肿瘤全切除3例,近全切除4例,大部分切除1例。术后血清PRL恢复正常4例。8例术后症状均有好转。结论 男性巨大垂体PRL腺瘤,可首选溴隐亭治疗,若颅内压增高症状明显,可选择手术治疗。术中尽可能全切除肿瘤,保护正常垂体,术后酌情继续应用溴隐亭治疗或放疗。     

侵袭性催乳素腺瘤治疗后海绵窦残留或伴空蝶鞍综合征

目的 探讨侵袭性催乳素(PRL)腺瘤经治疗后海绵窦残留伴空蝶鞍综合征的临床特征和治疗策略.方法 18例侵袭性PRL腺瘤(Knosp分级Ⅲ或Ⅳ级)经治疗后出现海绵窦肿瘤持续残留,首选药物治疗者9例,首选手术治疗结合药物和(或)放疗9例.结果 平均随访55个月,8例PRL水平正常,7例视力改善.14例因鞍内肿瘤吸收遗留空蝶鞍,7例PRL仍升高,其中5例有不同程度的视交叉下疝(P<0.05).PRL水平正常、无临床症状的7例患者采用低剂量溴隐亭治疗达到PRL水平和肿瘤体积的长期控制.结论 PRL腺瘤治疗后海绵窦肿瘤残留伴发空蝶鞍,这一现象应该引起高度重视,尤其对伴有视交叉下疝的病例,长期的密切随访是必需的.无内分泌和压迫症状的海绵窦残留病例可以采用低剂量的药物治疗达到长期的肿瘤控制和内分泌控制.     

垂体泌乳素腺瘤的手术治疗

垂体泌乳素（PRL）腺瘤为最常见的垂体瘤，尽管药物治疗可逆转大部分患者的临床症状、使PRL水平正常和缩小肿瘤体积，但仍具有一些不足，如大部分病人需长期服药、不能耐受药物的副作用以及肿瘤对多巴胺激动剂耐药等。近年来，垂体PRL腺瘤的手术治疗重新引起重视，尤其泌乳素微腺瘤，有人提出可作为一线治疗手段暇q。本文报道近十年垂体PRL腺瘤的手术治疗结果。     

术前影像学在垂体泌乳素腺瘤治疗中的意义

目的垂体泌乳素腺瘤临床治疗策略各家观点不一。本文旨在分析总结影像学在该疾病治疗策略确定中的潜在作用。方法对5年间326例垂体泌乳素腺瘤病例的临床表现、影像学特点、治疗策略的确定及疗效预后进行回顾性分析。结果平均年龄男性41．6岁，女性32．3岁。男性肿瘤直径平均38．05mm，其中83．3％肿瘤呈侵袭性生长，在女性则为15．25mm和49％。手术组平均血清泌乳素（PRL）水平男性1875．22ng／ml，女性376．6ng／ml。术后，男性降至385．84ng／ml（P〈0．05），女性PRL降至23．93ng／ml（P〈0．05）。微腺瘤不孕者术后受孕率达75％，高于药物治疗组33．33％（P〈0．05）。结论对于影像学上存在明显病灶的病例，显微手术可取得良好疗效，若术后血清激素控制不良或海绵窦残留侵袭肿瘤的病例可考虑辅助药物或放射治疗。对于影像学明确提示微腺瘤，尤其是有生育要求的女性病例，积极的显微手术可取得较好疗效。     

Galectin-3与垂体泌乳素瘤侵袭性的关系

目的探讨Galectin-3表达和人脑垂体泌乳素(PRL)腺瘤侵袭性的关系。方法应用免疫组织化学技术SP法检测38例垂体PRL腺瘤Galectin-3的表达。结果①侵袭PRL腺瘤与非侵袭PRL腺瘤组的Galectin-3阳性表达率分别为92．0%(23/25)和38．46%(5/13),两组之间差异显著(P＜0．01)。②Galectin-3表达与PRL肿瘤的大小及海绵窦侵袭有关(P＜0．05),但与年龄和性别无明显关系(P＞0．05)。结论Galectin-3与垂体PRL腺瘤侵袭性密切相关,Galectin-3可能在PRL腺瘤的侵袭性生长过程中起重要作用。     

Brain & chiasmal herniations into sella after medical treatment of prolactinoma

BACKGROUND: Dopamine agonists are widely used in the treatment of pituitary prolactinomas. We report a case of inferior mesial frontal lobe (gyrus rectus) and chiasmal herniations into an enlarged sella following successful medical treatment of a pituitary macroadenoma. METHOD: A 71-year-old healthy man presented to medical attention with visual complaints. On examination, he was found to have bitemporal hemianopsia. Endocrine evaluation revealed an elevated prolactin level. He was treated medically with a dopamine agonist (bromocriptine). RESULTS: Evaluation after one year of medical treatment revealed stabilization of the patient's vision, with a significant bitemporal field loss. Serum prolactin levels normalized (5.16 ng/ml). The MRI of the sella showed almost complete disappearance of the tumor, resulting in right mesial frontal lobe herniation inferiorly into an enlarged sella with associated chiasmal deformation. CONCLUSIONS: We report a case where successful medical treatment of a large pituitary prolactinoma has resulted in inferior frontal lobe and chiasmal herniatons into an enlarged sella.     

伽玛刀治疗对垂体泌乳素腺瘤内分泌功能的影响

目的 分析不同放射剂量γ-刀治疗对功能性泌乳素(PRL)腺瘤的PRL水平的影响,判断PRL在γ-刀治疗功能性PRL腺瘤预后和指导激素替代治疗的作用.方法 回顾性分析山东淄博万杰医院和广东深圳罗湖人民医院自2004年9月至2008年3月应用γ-刀治疗的248例功能性PRL腺瘤患者的临床资料,按治疗剂量将患者分组:Ⅰ组:50 Gy≤中心剂量<60 Gy;边缘剂量:20～30 Gy;Ⅱ组:40 Gy≤中心剂量<50 Gy;边缘剂量:15～25 Gy;Ⅲ组:30 Gy≤中心剂量<40Gy;边缘剂量12～20 Gy;术前、术后1月、3月、12月采用放射免疫法检测患者血清PRL水平,术后1年、2年复查头颅MRI观察肿瘤大小的变化.结果 3组患者术前PRL水平的差异有统计学意义(p<0.05),与Ⅰ、Ⅱ组比较,Ⅲ组PRL值偏低,术后12个月与Ⅰ组比较,Ⅲ组PRL值偏高;与术前相比,3组患者术后PRL水平均降低,差异有统计学意义(P<0.05);术后1年MRI显示肿瘤缩小198例(80%);术后2年肿瘤消失203例(82%),增大19例(7.7%),无变化26例(10.4%).结论 不同剂量γ-刀治疗功能性PRL腺瘤对术后内分泌的恢复有很大的影响,中心剂量和边缘剂量(尤其是中心剂量)较高时,术后PRL易恢复正常.但远期是否会造成垂体低功需要长期随访.

Abstract：

Objective To analyze the effects of-γ-knife treatment with different dosages on level of prolactin (PRL) in patients with different sizes of functional pituitary prolactinomas, and determine an index to guide hormone replacement therapy and the prognosis of -γ-knife treatment in patients with functional pituitary prolactinomas through comparing the changes of tumor sizes and the levels of PRL before and after -γ-knife treatment. Methods A retrospective analysis of the clinical data of 248 patients with functional pituitary prolactinomas was performed; gamma knife treatment was performed on these patients from September 2004 to March 2008. We divided the patients into 3 groups: group Ⅰ (50 Gy≤central dose<60 Gy, 20 Gy＜marginal dose<30 Gy), group Ⅱ (40 Gy≤ central dose＜50 Gy, 15 Gy＜marginal dose<25 Gy) and group Ⅲ (30 Gy ≤ central dose<40 Gy, 12 Gy＜marginal dose<20 Gy). The irradiation dose on optic nerves in the 3 groups was under 9 Gy. Radioimmunoassay was employed to detect the serum PRL level before and 1, 3 and 12 months after γ-knife treatment. The changes of the tumor sizes were observed and compared with cranial MRI 1 and 2 years after -γ-knife treatment.Results Significant differences on the PRL level were noted before -γ-knife treatment between each 2 groups (P<0.05); the PRL level in group Ⅲ was lower as compared with that in group Ⅰ and Ⅱ before γ-knife treatment; however, the PRL level in group Ⅲ was higher as compared with that in group 112 months after -γ-knife treatment; the PRL level in all the 3 groups after γ-knife treatment was significantly lower as compared with that before γ-knife treatment (P<0.05). MRI showed that the tumor had 80% partial response rate (198/248) in the 1st year, 82% complete response rate (203/248) in the 2nd year, increased volume in 19 patients (7.7%) and no change in 26 patients (10.4%). Conclusion Different treatment doses of Gamma knife on functional pituitary prolactinomas has great influences on postoperative recovery of endocrine; the higher doses of the center and edge (especially center), the higher normal rate of postoperative PRL level. Whether it will cause long-term hypopituitarism needs continue follow-up.     

溴隐亭治疗垂体泌乳素腺瘤后并发脑脊液漏处理二例报道并文献复习

目的 探讨溴隐亭治疗侵袭性垂体泌乳素腺瘤后并发脑脊液漏的原因、临床表现及处理方法.方法 分析中山大学附属第三医院神经外科收治的2例溴隐亭治疗后并发脑脊液漏的垂体泌乳素腺瘤患者的临床资料,并复习相关文献.结果 2例肿瘤均广泛侵犯颅底,在溴隐亭治疗后1个月内发生脑脊液漏.1例经停药及脑室外引流处理后脑脊液漏停止,另一例经停药、经蝶手术修复漏口及腰大池置管外引流后脑脊液漏停止.在腩脊液漏好转2周后均继续予以较小剂量溴隐亭治疗,随诊3年和9个月无脑脊液漏复发,血泌乳素水平渐下降,肿瘤渐缩小.结论 溴隐亭治疗合并颅底破坏的垂体泌乳素腺瘤时有并发脑脊液漏的可能.停药、手术修复漏口及脑脊液外引流是治疗此类并发症的有效方法.继续小剂量溴隐亭治疗可使肿瘤缓慢缩小并减少脑脊液漏发生的可能.     

Prolactin-secreting pituitary adenoma in neuroleptic treated patients with psychotic disorder

Three patients with psychoses and concomitant prolactin-secreting pituitary tumours are described. Patients A and B had bipolar and schizoaffective disorders, respectively. They had both been treated with neuroleptics for 20 years before the prolactinomas were revealed. Patient C developed a paranoid psychosis after two years of continuous bromocriptine treatment for a pituitary tumour. In patient A the prolactin level was successfully normalized and a good antipsychotic effect was maintained by combined therapy with haloperidol and quinagolide but not bromocriptine. In patient B the prolactinoma was removed by surgery, in view of the serious nature of the psychotic disorder, to avoid psychotic relapse by treatment with a dopamine agonist. In patient C a good result was obtained with the combination of clozapine and bromocriptine. These case reports support the view that neuroleptics being dopamine antagonists and dopamine agonistic agents which are the primary treatment of prolactinomas can cancel out each other’s effects. The combination of clozapine and quinagolide is recommended as the treatment of choice for most patients. Received: 17 March 1998 / Accepted: 20 October 1999     

“催乳素与肿瘤直径比”鉴别催乳素型垂体腺瘤

目的提出"催乳素与腺瘤直径比"的概念,探讨其在催乳素型与非功能型垂体腺瘤的鉴别诊断价值。方法回顾性分析我科2009年1月至2013年4月期间所收治经病理证实的催乳素型与非功能型垂体腺瘤,收集术前垂体激素水平及MRI资料,对比催乳素值与"催乳素与肿瘤直径比"的鉴别诊断效果。结果共有213例患者纳入分析。其中非功能型腺瘤160例,催乳素为0.65(0.04~6.06)nmol/L,催乳素与肿瘤直径比(催乳素/肿瘤最大直径)为0.03(0.00~0.23)nmol/(Lomm);催乳素型腺瘤53例,催乳素为18.56(0.99~439.73)nmol/L,催乳素与肿瘤直径比为1.35(0.11~10.60)nmol/(Lomm)。以催乳素水平鉴别时灵敏度为96.2%,特异度为88.1%;以"催乳素与肿瘤直径比"鉴别时的灵敏度为92.5%,特异度为98.1%。两者鉴别结果具有统计学差异(P0.001)。结论 "催乳素与肿瘤直径比"可用于催乳素型与非功能型垂体大腺瘤的鉴别诊断,比单纯的催乳素值更准确。     

Non-surgical management of cystic prolactinomas

Cystic prolactinomas are considered not amenable to dopamine agonist therapy. We present the results of dopamine agonist therapy in six patients with cystic prolactinomas. The inclusion criteria of patients were: (i) cystic macroadenomas with the cyst occupying more than 50% of the tumour volume; (ii) a serum prolactin value more than 150 ng/mL. All patients were males with a mean age of 35 years. The clinical presentations were erectile dysfunction in 66.6%, visual deficits in 50% and headache in 50% of patients. All patients were treated with bromocriptine only except one who was treated with both bromocriptine and cabergoline. The mean duration of follow up was 57.1 months. At the final follow-up 50% of patients had hormonal cure, 50% had radiological cure and 50% had reduction in the size of the tumour. Hence, it is appropriate to consider dopamine agonist therapy in patients with cystic prolactinomas before considering surgery.     

射波刀分次治疗海绵窦血管瘤的初步结果

目的 总结射波刀分次治疗海绵窦血管瘤( CSH)的初步经验.方法 应用射波刀治疗海绵窦血管瘤20例,肿瘤最大径为23.0～67.0 mm,平均42.0 mm.肿瘤平均体积为25.4 cm3.1例肿瘤照射1次,3例照射2次,其余16例肿瘤照射3次,周边剂量分别为13 Gy/1次;17.8～19.0 Gy/2次;18.4 ～21.0 Gy/3次.随访时间为7-36个月(平均15个月).结果 5例巨大肿瘤射波刀治疗后有轻微的症状加重,需要脱水治疗.所有患者均未出现新的脑神经受损症状.4例视力受影响者治疗后6个月改善,12例其他脑神经受损者症状改善或恢复正常.4例肿瘤缩小90％以上,9例缩小50％以上,4例缩小30％左右,1例未缩小,2例未复查MRI,但是症状改善.结论 射波刀治疗CSH的不良反应轻,初步疗效满意.对大型或巨大CSH,射波刀分次照射可成为其主要治疗手段之一.     

A prospective PET study of patients with glioblastoma multiforme

OBJECTIVE: To study the post-surgical metabolic and structural cerebral changes in patients with glioblastoma multiforme (GBM). MATERIALS AND METHODS: We examined ten patients prospectively with newly diagnosed GBM. All patients were primarily treated with surgery, followed by chemotherapy (carmustine, cisplatine and etoposide) and radiotherapy. Positron emission tomography (PET) was used to measure tumor- and cerebral metabolism. CT or MRI was used to estimate tumor volume by measurements of tumor area. RESULTS: Tumor metabolism was not increased during chemotherapy (P = 0.71), but increased during radiotherapy (P = 0.01). CT/MRI showed similar results with no increase in tumor area during chemotherapy (P = 0.33) but increase during radiotherapy (P = 0.002). During the entire study, tumor metabolism and area increased evenly (P = 0.01). CONCLUSIONS: Our study did not show a gain of PET compared with structural imaging in the prospective evaluation of GBM. We found a difference in metabolic increase and tumor growth between the two treatment regimens, although this finding has limited relevance due to the design of the study.