垂体高度的断层解剖及MRI测量

目的：通过尸体断层标本和MRI对照测量垂体的高度，为垂体的影像学诊断提供诊断标准、材料和方法：利用35例成人尸体断层标本，在各个断面上测量垂体的高度；在103例成人冠状头颅MRI上测量垂体的高度，并按年龄和性别分为十二组。将断层标本和MRI的测量数据进行比较。结果：在断层标本上测量垂体的平均高度为5．3±0．6（4．0－7．6）mm；MRI上的平均高度为5．4±1．3（4.0－8．3）mm。两组数据比较，无显著性差异（P＞0．05）。男性垂体的平均高度为5．3±1.2（4．0－7．2）mm，女性垂体的平均高度为5．5±1．4（4．0－8.3）mm。女性垂体的平均高度大于男性。各年龄组比较显示，20岁以后，随年龄增长，垂体高度逐渐下降。结论：在MRI诊断中，垂体高度女性≥9mm，男性≥8mm可考虑垂体异常。垂体高度女性大于男性；20岁以后，随年龄增长，垂体高度有逐渐下降的趋势。     

Intra-vascular tumour in pleomorphic adenomas—a report of four cases

Aims : The aim of this study was to report four cases of pleomorphic adenoma which were characterized by intra-vascular tumour. Methods and results : The patients ranged in age from 13–43 years, one was male while three were female. The tumours were situated in the parotid gland, submandibular gland and palate (two cases). The intra-vascular tumour consisted of single, clustered and solid cords of cells within multiple muscular walled blood vessels and capillaries both in the capsule and in the tumour. Immunoperoxidase staining confirmed that the intra-vascular cells were phenotypically identical to those of the tumour. The possibility that the intra-vascular tumour represents artefactual 'spillage' has been considered, however there is some histological evidence suggesting that this phenomenon represents true vascular invasion. Conclusions : The biological significance of intra-vascular tumour in pleomorphic adenomas is unknown. Thus far there has been no correlation with either recurrence or metastases.     

伽玛刀治疗垂体大腺瘤临床分析(附30例报告)

目的 研究伽玛刀治疗垂体大腺瘤的效果及影响疗效的因素。方法 30例垂体大腺瘤病人用1．0T磁共振定位，Gamma-plan计划系统规划，等剂量曲线45％～60％(平均49．7％)，周边剂量12～35Gy(平均22.9Gy)，中心剂量24～70Gy(平均45．4Gy)．Leksell伽玛刀实施放射外科治疗。分析治疗后垂体大腺瘤病例，总结其疗效和影响疗效的因素。结果 随访12～60个月，平均28个月，肿瘤完全消失6例(20％)，肿瘤缩小19例(63．3％)，无变化5例(16．7％)；19／20(95．5％)功能性垂体腺瘤内分泌症状改善，临床症状好转，1例过早绝经(年龄36岁)；5／10(50％)无功能性垂体腺瘤体积缩小．症状改善。结论 伽玛刀对于垂体大腺瘤仍是一种有效的治疗方法，其疗神与腺瘤的举类型、体积、照射剂量、剂量体剂、MRI信号特征密切相姜。     

显微镜下经单鼻孔蝶窦入路切除垂体腺瘤

目的评价显微镜下经单鼻孔蝶窦入路切除垂体腺瘤的疗效. 方法采用经单鼻孔蝶窦入路行垂体腺瘤切除术20例,其中微腺瘤8例(<10 mm),小腺瘤8例(10～20 mm),中腺瘤3例(20～30 mm),大腺瘤1例(>30 mm);PRL腺瘤9例,GH腺瘤6例,ACTH腺瘤5例. 结果本组20例无并发症,平均随访5(2～10)个月,患者临床症状较术前均有不同程度改善,手术效果良好. 结论经单鼻孔蝶窦入路垂体瘤切除术效果好,术中损伤小,患者痛苦少,术后康复快,没有或较少出现并发症.     

Pituitary volume in pediatric obsessive-compulsive disorder.

BACKGROUND: Abnormalities in the limbic-hypothalamic-pituitary-adrenal (LHPA) axis have been implicated in the pathogenesis of obsessive-compulsive disorder (OCD). To our knowledge, however, no prior study has measured pituitary gland volume in OCD. METHODS: Volumetric magnetic resonance imaging studies were conducted in 31 psychotropic drug-na?ve children (10 boys, 21 girls) aged 8-17 years and 31 case-matched healthy comparison subjects. RESULTS: Pituitary volume was significantly smaller in patients with OCD as compared with healthy control subjects (11% smaller). Smaller pituitary volume in patients with OCD was associated with increased compulsive but not obsessive symptom severity. Boys with OCD had smaller pituitary gland volumes compared with control boys (20% smaller). No significant differences in pituitary volume were observed between girls with OCD and control girls. Boys with OCD had significantly smaller pituitary volumes than girls with OCD (31% smaller), whereas control boys also had smaller pituitary gland volumes compared with control girls (21% smaller). CONCLUSIONS: These findings provide new evidence of reduced pituitary volume in pediatric OCD that seems to be more prominent in male patients. The observed alterations in pituitary volume are consistent with neuroendocrine studies that have reported abnormalities in the LHPA axis in OCD.     

垂体腺瘤性男性不育

垂体腺瘤是男性不育的重要病因。现代内分泌和影像学检查能够早期诊断垂体腺瘤引起的男性不育症。针对垂体腺瘤的病因治疗是治疗此类不育症的最佳选择。     

Increase of prolactin mRNA in the rat hypothalamus after intracerebroventricular injection of VIP or PACAP

Vasoactive intestinal peptide (VIP), the structurally homologous pituitary adenylate cyclase-activating peptide (PACAP) and the pituitary hormone, prolactin (PRL) enhance rapid eye movement sleep (REMS). VIP and PACAP are both inducers of PRL gene expression and release in the pituitary gland. Little is known about PRL regulation in the brain although it is hypothesized that the REMS-promoting activity of i.c.v. administered VIP may be mediated via the activation of cerebral PRL. To test whether VIP or PACAP in fact increase intracerebral mRNA, the peptides (VIP: 30 or 300 pmol; PACAP: 220 pmol) were injected i.c.v. into rats at dark onset. 1 h later, cDNA was synthesized from purified hypothalamic mRNA. Standardized amounts were analysed for PRL using the polymerase chain reaction followed by Southern blotting and hybridization. Compared with β-actin mRNA levels, both VIP and PACAP increased PRL mRNA levels in a dose-dependent fashion though VIP was more effective on a molar basis. The previously reported alternatively spliced PRL mRNA (lacking exon 4) was not detected. The data support the hypothesis that the REMS-promoting activity of central VIP and PACAP might be mediated by cerebral PRL.     

Association of multiple liver cell adenomas with spontaneous intrahepatic portohepatic shunt

The association of multiple liver cell adenomas containing foci of focal nodular hyperplasia with a spontaneous intrahepatic portohepatic venous shunt is reported in a 13-year-old male patient. At least eight nodules less than 10 cm in diameter were recognized and proved by means of surgical resection or surgical biopsies. These lesions were heterogeneous and hypodense on precontrast computed tomographic (CT) scans, and were slightly enhanced after injection of contrast medium. At magnetic resonance (MR) imaging, the signal intensity of these nodules varied. It was either hyperintense or hypointense on T1-weighted SE images. Sonography and angiography demonstrated a portohepatic venous shunt and hepatic arterialization was observed. These findings emphasize the hypothesis that hepatic arterialization may cause the development of liver cell adenomas. Moreover, it is suggested that liver cell adenoma and focal nodular hyperplasia have a common pathogenesis.     

多激素分泌性垂体泌乳素腺瘤的激素分泌谱及克隆分析

目的 对多激素分泌性垂体泌乳素腺瘤的克隆状态以及激素分泌谱进行分析。方法 对26例女性垂体泌乳素腺瘤患者（单激素分泌性PRL腺瘤7例，多激素分泌性PRL腺瘤19例）进行肿瘤标本的免疫组化分析，并且提取DNA行HUMARA分析。结果免疫组化分析提示本组多激素分泌性垂体PRL腺瘤具有10种不同的激素分泌谱，现代分子生物学HUMARA克隆分析提示11／13例（85％）多激素分泌性垂体PRL腺瘤为单克隆起源。结论 结果提示垂体泌乳素腺瘤除了分泌泌乳素外，还可以分泌多种垂体激素，而且绝大多数多激素分泌性垂体腺瘤的起源是单克隆性的。     

125I-抑制素在大鼠垂体和下丘脑的放射自显影研究

目的研究抑制素（INH）在体条件下能否通过大鼠的血脑屏障及在垂体或下丘脑的分布。方法采用颈静脉灌流和放射自显影技术，将20只SD大鼠分为4组，每组5只，第1～3组（实验组）颈静脉注射^125 I-INH50μl，第4（对照）组注射等量的生理盐水。第1，2，3组分别于注射后30，60和120min断头处死，取出垂体、下丘脑，以生理盐水洗涤，测量放射性计数，取放射性最大组的垂体与下丘脑组织行放射自显影分析。结果第1组垂体的放射性最高[（1008．00±5．78）Bq]，而第2和3组分别为（723．00±4．95）和（491．00±4．90）Bq；1～3组的下丘脑放射性分别为（20．00±1．01），（22．00±0．95）与（19．00±0．73）Bq。第4组垂体与下丘脑的放射性分别为（16．00±1．40），（15．00±0．98）Bq。各实验组大鼠垂体的放射性与对照组差异有统计学意义（P〈0．01），且在注射后30min放射性最大（第1组），60和120min后逐渐降低；而实验组与对照组大鼠的下丘脑放射性差异无统计学意义（P〉0．05）；放射自显影结果示，实验组大鼠的垂体组织上有明显的银颗粒，而对照组没有；实验组和对照组大鼠的下丘脑组织上均未见明显的银颗粒。结论^125I-INH能通过大鼠血脑屏障，垂体在注射后30min放射性最大，在大鼠垂体上有INH结合位点或受体，而在其下丘脑没有。