生长激素水平正常的肢端肥大症1例并文献复习

Acromegaly with normal basal growth hormone levels:A case report and literature review

肢端肥大症最常见的原因是生长激素(growth hormone,GH)分泌过多。本文报道1例42岁肢端肥大症女性,因间断头痛伴颜面改变、肢端粗厚入院,无性功能改变及溢乳,基础GH水平、胰岛素样生长因子-1(insulin-like growth factor 1,IGF-1)及泌乳素(prolactin,PRL)水平在正常范围,磁共振(magnetic resonance imaging,MRI)增强显示大小约0.5 cm结节状异常强化影,行经蝶窦鞍区病损切除术,术后病理证实为垂体生长激素瘤,免疫组织化学显示GH阳性,灶状PRL阳性。正常或低基础GH的肢端肥大症临床上十分罕见,具体发病机制尚不完全清楚,有待进一步研究。

The most common cause of acromegaly is excess of growth hormone(GH)secretion.Here we report a 42-yearold female patient,who was admitted to hospital for intermittent headache with facial change and acral thickening.There was no sexual function change and galactorrhea.Basal serum GH level,insulin-like growth factor 1(IGF-1)level and prolactin(PRL)level were within normal range.Magnetic resonance imaging(MRI)enhanced scan showed a nodular abnormally enhanced shadow measured about 0.5 cm,which was removed through transsphenoidal microsurgery.After operation,pathology confirmed a GH-secreting pituitary adenoma and immunohistochemical study of the tumour showed positivity for GH and focal positivity for PRL.It is clinically rare in the acromegaly with low or normal basal GH level.Its specific pathogenesis is not fully understood,which needs further study.