Hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome with pituitary apoplexy

After hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome was diagnosed in a 35-year-old woman at 39 weeks' gestation, magnetic resonance imaging and hormone examination revealed pituitary apoplexy with panhypopituitarism and diabetes insipidus. Evaluation of pituitary function should be considered in patients with HELLP syndrome.     

Pituitary Insulin: Insulin-Like Growth Factors

Insulin-like growth factor (IGF)-I and IGF-II peptides as well as their mRNAs are produced in many organs, including the pituitary. Although IGF-I and IGF-II peptides are localized in endocrine cells of the anterior pituitary, IGF-I mRNA can be detected throughout the adenohypophysis, and IGF-II mRNA is abundant in intermediate and neural lobes. It is well-established that both circulating and intrinsic IGF-I are negative regulators of pituitary GH production. Other functions of intrinsic IGFs in normal and tumorous pituitary are just emerging. IGF-I may play a role in the stimulation of PRL synthesis and mediation of proliferative effects of estrogen on lactotroph. Compared with IGF-I, the function of IGF-II has not been clarified so far. The growth-promoting actions of IGFs are mediated by IGF-I receptor. The role of local and circulating IGFBPs in pituitary are not yet documented. IGFBPs in other tissues have inhibitory and stimulatory effects on IGFs, and can act independently from the IGFs as well. IGFs have been reported to promote cell proliferation in many tumors. However, the extent to which IGFs contribute to pituitary tumor development and growth remains obscure.     

经单鼻孔-蝶窦入路切除馒袭性垂体腺瘤

目的探讨采用单鼻孔-蝶窦入路切除侵袭性垂体腺瘤的方法。方法对经神经导航及神经内镜辅助的单鼻孔-蝶窦入路手术治疗的37例侵袭性垂体腺瘤患者的临床资料进行回顾性分析。结果镜下全切除21例,次全切除10例,大部分切除6例,无死亡。术后有脑脊液鼻漏2例,1例经保守治疗后治愈,另1例经手术修补治愈。患者术后原有症状均有所改善。结论经单鼻孔-蝶窦入路切除侵袭性垂体腺瘤具有手术时间短、创伤小、安全且并发症少等优点。术中利用神经导航系统和神经内镜辅助手术避免重要结构损伤,提高肿瘤的切除程度,值得推广。     

巨大型垂体腺瘤的显微外科手术治疗

目的 探讨扩大前颅底经纵裂经平台蝶窦入路手术治疗巨大垂体腺瘤的疗效。方法 1999年12月～2004年12月，对21例巨大型垂体腺瘤采用扩大前颅底经纵裂经平台蝶窦入路进行显微外科手术治疗，术前均经MRI检查，肿瘤最长径平均4、8（4．0～7．5）cm。结果 肿瘤全切除18例（85．7％），次全切除3例（14．3％），无手术死亡病例。术后患者症状均有所改善，但发生脑脊液漏1例，短时尿崩4例，2例未能保留嗅神经，1例仅保留1侧。术后平均随访2．5（0．5～5．5）年，复查内分泌检查、MRI未见复发。结论 此入路视野广阔、暴露良好、无严重并发症，可提高巨大垂体腺瘤的手术效果。     

探讨服中求阳与阳中求阴对谷氨酸单钠大鼠下丘脑—垂体— …

目的：研究弓状核（ＡＲＣ）毁坏后下丘脑－垂体－肾上腺－胸腺（ＨＰＡＴ）轴的变化以及与肾阴肾阳的内在联系。方法：给 出生后（第２、４、６、８、１０天）大鼠每天皮下注射左旋谷氨酸单钠（ＭＳＧ）４ＭＧ／Ｇ损毁下丘脑ＡＲＣ,成年后分别以左 右归饮灌胃（每天５ｇ／ｋｇ）结果：ＭＳＧ大鼠下丘脑室旁核促肾上腺皮质激素释放激素（ＣＲＨ）阳笥细胞及垂体前叶肿肾上腺皮质激素（ＡＣＴＨ）分泌细胞数量明显多于生理盐水组,     

MRI动态增强及FFE序列在垂体微腺瘤诊断中的作用

目的:探讨 MRI动态增强及 FFE序列对垂体微腺瘤的诊断价值。方法:对 5 6例垂体微腺瘤先行矢状位及冠状位 T1 WI和 T2 WI成像 ,然后进行 GD- DTPA冠状 T1 WI动态增强扫描 ,随之行冠状 T1 WI常规延迟 FSE和 FFE序列增强扫描。 结果 :(1)平扫 :直接征象显示 2 8例 (5 0 .0 % ) ,间接征象出现最多为垂体上缘局限膨隆 ,占5 0 %。(2 )平扫显示 2 8例 (5 0 .0 % ) ,动态增强显示 5 5例 (98.2 % ) ,常规延迟增强显示 4 8例 (85 .7% ) ,三者检出率相比差异有统计学意义 (P<0 .0 0 5 )。 5例只有动态增强能显示。 (3) FSE序列显示 4 8例 (85 .7% ) ,清楚显示 2 6例 ;FFE序列显示 5 1例 (91.1% ) ,清楚显示 35例。两者检出率相比差异有统计学意义 (P <0 .0 5 )。结论:MRI动态增强扫描与常规延迟增强 (FFE序列 )扫描明显提高病变检出率 ,可以避免病变遗漏。     

120例垂体生长激素腺瘤及多激素腺瘤的临床和病理学特点分析

目的分析120例垂体生长激素（GH）腺瘤及多激素腺瘤患者的临床及病理学特征。方法回顾性分析120例免疫组化证实的垂体GH腺瘤及多激素腺瘤患者的临床资料,包括临床表现、生化改变、病理分型及侵袭性等。结果垂体腺瘤的好发年龄为20~50岁,男女发病比约为1：2,主要的临床表现为肢端肥大、头痛头晕、视力下降、视野缺损,女性患者表现有闭经、泌乳或月经紊乱。本组各种类型的垂体腺瘤的侵袭性比例：GH（＋）腺瘤为59.57%（28/47）、GH（＋）及PRL（＋）二种激素混合性瘤为35.48%（11/31）、GH（＋）和ACTH（＋）为33.33%（1/3）、GH（＋）和TSH（＋）为0（0/4）、GH（＋）和LH（＋）为33.33%（1/3）,以及GH（＋）及其它二种以上激素（＋）的多激素腺瘤34.38%（11/32）。单纯GH垂体腺瘤的侵袭性明显高于GH（＋）伴其它激素（＋）的垂体腺瘤的侵袭性（P0.05）。结论本组病例女性多于男性,单纯GH垂体腺瘤侵袭性明显高于其他类型的垂体腺瘤;病理免疫组化提示GH腺瘤除GH（＋）外,常常伴随其他激素（＋）。     

Investigation and management of adrenal disease

Disorders of the adrenal gland are rare and complex, with many potential pitfalls in management. An understanding of embryology, anatomy, physiology and biochemistry is crucial. There has been a dramatic increase in the incidental detection of adrenal lesions on cross sectional imaging in recent years. Surgical treatment may be required for syndromes of hormonal excess and/or suspicion of malignancy.