异位垂体腺瘤的诊断与治疗（附三例报告并文献复习）

Diagnosis and treatment of ectopic pituitary adenoma： a report of 3 cases and literature review

目的探讨异位垂体腺瘤的概念、发生机制、临床表现、诊断、治疗和预后。方法回顾性分析南京医科大学附属脑科医院神经外科自2010年9月至2011年3月收治的3例异位垂体腺瘤患者的临床资料，并结合相关文献进行讨论。结果临床表现为头痛2例，性功能减退伴双眼视物模糊1例，肢端肥大伴精神症状1例；内分泌检查显示血生长激素（GH）和催乳素（PRL）水平明显增高各l例；MRI平扫显示蝶窦内占位2例，蝶窦及斜坡占位1例，MRI增强显示上述病灶明显强化：采用单鼻孔一蝶窦入路，显微镜或内窥镜下肿瘤全切2例，蝶窦及斜坡占位行部分切除1例，术后病理诊断均为垂体腺瘤。结论异位垂体腺瘤主要表现为神经功能障碍和（或）内分泌紊乱，头颅CT、MRI具有一定的诊断价值，手术全切肿瘤可获得良好的疗效。

Objective To explore the conception, mechanism, clinical manifestations, diagnosis, treatment and prognosis of ectopic pituitary adenoma. Methods The clinical data of 3 patients with ectopic pituitary adenoma, admitted to our hospital fi＇om October 2010 to March 2011, were retrospectively analyzed and discussed by reviewing the relevant literature. Results Clinical manifestations ofectopic pituitary adenoma were as follows： 2 had headache, 1 had sexual dysfunction and blurred vision, and 1 had acromegalia combined with psychiatric symptom. Endocrinological examination showed that 1 had obviously increased growth hormone （GH） and 1 increased prolactin （PRL）. MRI scan indicated that 2 were located in sphenoid sinus and 1 was located in the sphenoid sinus and clivus. Contrast-enhanced MRI showed enhanced lesions. Total removal was achieved in 2 patients through the trans-sphenoidal approach; partial removal was achieved in the patient with sphenoid sinus and clivus. Pathology examination demonstrated as pituitary adenomas. Conclusion The patients with ectopic pituitary adenoma have neurological dysfunction or/and endocrinological dysfunction; CT and MRI play valuable role in their diagnosis; radical resection of tumor can achieve satisfactory clinical outcomes.