垂体细胞增生的诊断和治疗

The Diagnosis and Treatment of Pituitary Hyperplasia

目的探讨垂体细胞增生的诊断与治疗。方法男性2例,女性42例,平均年龄28.7岁,平均病程2.4年。临床表现和内分泌检查符合闭经泌乳综合征13例,库欣综合征11例,巨人症1例,无内分泌功能紊乱19例。蝶鞍MRI正常3例,垂体上缘膨隆30例,蝶鞍内信号不均匀26例,垂体柄偏斜17例。44例均行经口鼻蝶窦显微外科垂体探查术。结果44例术后病理均为垂体前叶细胞增生,随访3个月至5年。闭经泌乳患者术后改善12例,复发1例。库欣综合征患者术后改善8例,稳定1例,复发2例。巨人症患者术后无改善。无内分泌功能紊乱症状患者术后改善14例。结论垂体细胞增生在术前很难明确诊断,手术疗效较垂体腺瘤差,易复发。

Objective To discuss the diagnosis and treatment of the pituitary hyperplasia. Methods Among the 44 patients with pituitary hyperplasia, 2 cases were male and 42 were female. Mean age was 28. 7 yrs old and mean history was 2. 4 years. Among them, 13 （ 29. 5% ） had amenorrhea-galactorrhea syndrome, 11 （25%） had Cushing＇s syndrome, 1 （2.3%） had gigantism, and 19 （43.2%） didn＇t have symptoms of endocrine disturbance. MRI showed normal in 3 cases, increase of the height of pituitary in 30 cases, hypointensity on Tl-weighted images in 26 cases, and deviation of the pituitary pedicle in 17 cases. All patients underwent trans-spheniod hypophysectomy. Results Pathology showed pituitary hyperplasia in all 44 cases. Postoperative follow-up were 3 months to 5 years. Among 13 amenorrhea-galactorrhea syndrome, 12 improved, 1 recurred. Among 11 Cushing＇s syndrome, 8 improved, 1 stabled, 2 recurred. 1 gigantism didn＇t improve. Among 19 other non-endocrine symptoms, 14 improved. Conclusion Preoperation diagnosis of pituitary hyperplasia was difficult. The effect of hypophysectomy and the prognosis were not as good as pituitary adenoma.