摘要
目的讨论复发性垂体促肾上腺皮质激素(ACTH)腺瘤的诊断和治疗。方法男性6例,女性12例。年龄8～43岁,平均25.7岁。平均病程29.5个月。均表现典型库欣综合征,诊断为垂体ACTH腺瘤行经蝶手术,术后病理为垂体腺瘤。术后皮质醇曾降至正常半年以上,再次出现库欣综合征,血和尿皮质醇增高,CT或MRI显示9例垂体腺瘤复发。12例采用再次经蝶手术,术中9例发现肿瘤,3例未发现肿瘤。6例未再行手术,其中4例行垂体放疗和肾上腺切除术,2例行肾上腺切除术。结果随诊1～12年,再次经蝶手术的治愈缓解率为58%(7/12)。共有7例行垂体放疗加肾上腺切除术,4例行肾上腺切除术,术后皮质醇下降,有5例需用激素替代治疗。结论对于复发性垂体ACTH腺瘤首先应进行再次经蝶手术,如果术后皮质醇仍高,可行垂体放疗和/或肾上腺切除术。
Objective To discuss the diagnosis and treatment of recurrence of adrenocortieotrophie-hormone secreting pituitary adenomas. Methods Eighteen cases of recurrence of adrenocortieotrophie-hormone secreting pituitary adenomas were investigated in these retrospective studies including 6 males and 12 females. They ranged from 8 to 43 years old, with a mean of 25.7 years old. Mean history was 29.5 months. Pituitary adenomas were diagnosed with clinical symptoms, endocrinic examination and CT or MRI. Transsphenoidal surgeries were performed on all the patients and pituitary ACTH adenomas were confirmed by pathological examinations. Good effects lasted for more than half a year after operation in all patients before they suffered from recurrence of the same symptom. Serum and urinary free cortisol （UFC） increased in all patients and recurrence of pituitary adenomas were showed in CT or MRI in 9 patients. Repeated transsphenoidal surgery, were performed on 12 patients, including pituitary adenomas in 9 patients and no adenomas in other 3 patients. In 6 patients not treated with repeated transsphenoidal surgery., pituitary irradiation and adrenalectomy were taken on 4 patients and simple adrenalectomy on 2 patients. Results The follow-up was 1 to 12 years. The remission rate in repeated transsphenoidal surgery was 58% （7/12）. Irradiation and adrenalectonly were taken on 7 patients and adrenalectomy were only performed on 4 patients. Glucocortieoid substitution therapy were performed in 5 patients. Conclusion Repeated transsphenoidal surgery should be selected firstly for recurrence of adrenocorticotrophie-hormone secreting pituitary adenomas. Pituitary irradiation and adrenalectomy are assistant treatment for patients who still had high secretion of cortisol.
出处
《中华神经外科疾病研究杂志》
CAS
2005年第5期402-405,共4页
Chinese Journal of Neurosurgical Disease Research
关键词
垂体腺瘤
复发
诊断
手术
Pituitary adenomas
Recurrence
Diagnosis
Surgery
