鼻咽癌放疗后垂体功能减退的临床研究  

Radiation-induced hypopituitarism in patients with nasopharyngeal carcinoma

作　　者：胡斌[1] 蔡望青[1] 容小明[2] 沈庆煜[2] 唐亚梅[2] 

机构地区：[1]中山大学孙逸仙纪念医院神经外科,广州510120 [2]中山大学孙逸仙纪念医院神经科,广州510120

出　　处：《中华神经医学杂志》2012年第1期61-64,共4页Chinese Journal of Neuromedicine

摘　　要：目的 探讨鼻咽癌放疗后垂体功能减退（RIH）的临床特点及影像学表现. 方法 回顾性分析自2000年至2010年在中山大学孙逸仙纪念医院就诊的鼻咽癌放疗后诊断为RIH的9例患者临床资料（男7例,女2例）,分析其临床表现、激素水平、影像学表现及后期随访结果. 结果 9例患者均诊断为RIH,距离放疗结束的时间为10月～15年.5例患者发现1种以上垂体分泌激素的紊乱,其中甲状腺激素分泌减少和高催乳素血症是最常见的表现,其次是促肾上腺皮质激素分泌减少.2例患者影像学表现为垂体萎缩和空泡蝶鞍.5例患者经激素替代治疗后症状改善.结论 鼻咽癌放射治疗可导致垂体功能损害,大部分患者表现为亚临床症状并缺乏典型垂体改变,早期、定期的激素监测和影像学随访对于RIH的早期诊断和治疗尤为重要.Objective To investigate the clinical characteristics and imaging features of radiation-induced hypopituitarism （RIH） in nasopharyngeal carcinoma （NPC） patients after radiotherapy.Methods Retrospective study was performed on the clinical data of 9 NPC patients （7 males and 2 females）, diagnosed as RIH after radiotherapy in our hospital from 2000 to 2009; their clinical manifestations, anterior-pituitary hormone levels, cranial MRI features and follow-up results were analyzed. Results The interval between complications after radiotherapy and diagnoses of RIH varied from 10 months to 15 years.Multiple hormone deficits appeared in 5 patients; thyrotropin deficiency and hyperprolactinemia were the most common complications, followed by adrenocorticotropic hormone （ACTH） insufficiency.Typical radiological imaging of the pituitary gland displayed partially empty sella and atrophy of pituitaly gland,which was demonstrated in 2 patients.Five patients got improvement after hormone replacement therapy. Conclusion Radiation-induced hypopituitarism may occur in NPC patients; most patients are subclinical without typical radiological alterations in MRI for pituitary.Routine evaluation of adenohypophysis function is necessary for early detection of hormone deficiency and early hormone replacement treatment.

关 键 词：垂体功能减退 鼻咽癌 腺垂体激素 放射治疗 

分 类 号：R739.63[医药卫生—肿瘤]