垂体瘤伴腺垂体功能减退诊疗进展  

Evaluation and Replacement of Hypo-pituitary in Pituitary Tumor

作　　者：殷琪淇 李海[1] 季文[1] 王宇[1] 廖志红[1] 

机构地区：[1]中山大学附属第一医院内分泌科及垂体瘤中心,广东广州510080

出　　处：《中国神经肿瘤杂志》2013年第4期230-235,共6页Chinese Journal of Neuro-Oncology

基　　金：上海诺华贸易有限公司项目研究[No.Original 2013(2618)-OBU(505)-10(272)]

摘　　要：本文综述了垂体瘤手术前后腺垂体功能减退的诊断和治疗,着重讨论生长激素(GH)/胰岛素样生长因子(IGF)轴、催乳素(PRL)、促甲状腺激素(TSH)轴、促肾上腺皮质激素(ACTH)轴(不包括下丘脑-垂体-性腺轴的内容)。目前临床上,存在着不少甲状腺激素替代不充分或糖皮质激素超量使用的现象,一定程度上影响着垂体瘤的治疗效果。手术前后对甲状腺和肾上腺轴功能进行准确评估对于垂体瘤患者的合理治疗显得十分重要。本文全面综述了近年来TSH和ACTH轴功能低下的评估和替代治疗的新观点。此外,GH轴在垂体前叶功能减退时最易受累.临床上常容易忽视GH激素缺乏的评估和治疗,成人GH合理补充治疗能有效改善患者身体组成和骨健康,降低心血管疾病风险,提高生活质量。本文一并讨论了成人GH合理补充的方法,认为长期规范随访和及时调整药物剂量十分必要。We reviewed the evaluation and replacement of hypo-pituitary before or after pituitary tumor surgery, focusing on the growth hormone （GH） / insulin-like growth factor （IGF） axis, prolactin （PRL）, thyroid stimulating hormone （TSH） axis, and adrenocorticotropic cortical hormone （ACTH） axis, not including the hypothalamic-pituitary-gonadal axis that will be discussed in another review. In clinics, there existed insufficient thyroid hormone replacement and over dosage of corticosteroid, which impacted on the treatment of pituitary tumor. So, functional evaluation of pituitary-adrenal and pituitary-thyroid axis are critical for patients with pituitary tumors. Here we supplied with the new ideas involved in the two axis. In addition, GH deficiency is most likely to happen and to be ignored in pituitary adenoma. Reasonable GH administration would improve the patient＇s body composition, bone health, quality of life, and reduce the risk of cardiovascular disease. This review also discussed the reasonable replacement of GH. The long-term follow-up and timely dose adjustment for all hormones are required.

关 键 词：垂体瘤 腺垂体功能减退 替代疗法 

分 类 号：R739.41[医药卫生—肿瘤]