90例垂体生长激素瘤临床诊断及治疗分析

Diagnosis and treatment of 90 patients with pituitary GH-secreting adenoma

  • 摘要: 90例垂体生长激素(GH)瘤患者,首发症状以面容变丑、肢端肥大最多,为83例(92%)。28例(31%)视力明显减退,24例(26.7%)双眼或单眼颞侧或外上象限偏盲,合并糖尿病和糖耐量减退共33例(36.7%)。90例患者基础血清GH水平均>5μg/L,其中>80μg/L者34例。39例行3h100g葡萄糖抑制GH试验,18例行阿托品抑制GH试验,两组患者GH水平均不能被抑制到<5μg/L水平。88例患者行头颅CT检查均发现垂体瘤,90例患者经手术证实大腺瘤41例(45.6%),微腺瘤49例(54.4%)。肿瘤向鞍上池扩展者33例。术后33例患者接受放射治疗,术后或以后1~5年随诊中62.8%患者血清GH水平正常(<5μg/L),92.3%的患者GH水平较术前下降。7例患者视力增加或视野扩大。手术并发症发生率为8.9%(8例)。

     

    Abstract: The earliest and most common manifestations in 83 of 90 patients with pituitary GH-secreting adenoma were coarsing of facial features and enlarged extremities.Decresed visual acuity and visual fields defect occured in 28 cases(31%) and 24 cases(26.7%) respectively. In 2l patients the disease was accompanied by diabetes millitus and in 12 patients by IGT.The basal GH level in all of the 90 patients was >5μg/L and in 34 cases >80μg/L. The functional GH secretion was not decreased to < 5μg/L.after oral administration of glucose in 39 patients or 0.6 mg atropine in 18 patients.The plasma PRL level was >25μg/L(2~126μg/L ) in 14 of 26 patients. The CT scan or MRI examination in 88 patients showed the evidence of pituitay adenoma. All of 90 patients received the treatment of operation,macroadenomas were found in 41 cases(45.6%) and microadenomas in 49 cases(54.4%) ,suprasellar extension of the adenoma revealed in 33 cases,among them,11 cases presented compression of the optic chiasm,invasion of the adenoma into cavernous sinus or sphenoidal sinus in 14 cases,and compression of the third cranial nerve and carotisinterna arteria in 3 cases.33 patients received postoperation radiotherapy.The GH level decreased in 92.3%(71/77 cases) ,and it was <5μg/L,after operation in 62.8%(48/77 cases) . The visual condition improved in 7 patients after operation.The total operative complications including diabetes insipitus,intracranial infection,hemorrhage and CSF rhniorrhea were 8.9%(8/90 cases) .These results indicate that most patients with GH-secreting adenoma presented typical clinical manifestations and good response to operation and radiotherapy.

     

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