育龄期女性少见类型垂体腺瘤的临床特征分析  

Clinical features of reproductive age female with rare pituitary adenomas

作　　者：黄新梅[1] 刘军[1] 李士其[2] 吴跃跃[1] 盛励[1] 徐炯[1] 陈灶萍[1] 丁和远[1] 查兵兵[1] 王芳[1] 杨敏[1] 

机构地区：[1]复旦大学附属上海市第五人民医院内分泌代谢科,上海200240 [2]复旦大学附属华山医院神经外科

出　　处：《临床内科杂志》2016年第11期740-743,共4页Journal of Clinical Internal Medicine

摘　　要：目的探讨育龄期女性少见类型垂体腺瘤患者的年龄分布、肿瘤大小、临床表现、影像学特征、激素水平、病理特点及治疗效果。方法回顾性分析120例15～50岁少见垂体腺瘤女性患者的临床资料，并对其进行随访。结果120例患者中，催乳素（PRL）＋生长激素（GH）混合瘤（25．8％）、裸细胞腺瘤（24．2％）、促皮质激素（ACTH）腺瘤（19．0％）、多激素表达腺瘤（15．8％）及促卵泡激素瘤（15．2％）为前5种少见类型垂体腺瘤；肿瘤均以大腺瘤为主，患者PRL均升高，中位PRL水平分别为98．18μg/L、30．83μg/L、33．14μg/L、61．50μg/L及78．82μg/L。ACTH腺瘤以沉默性为主（91．3％），术前随机ACTH水平与免疫组化ACTH阳性无关（P〉0．05）。FSH瘤患者术前FSH水平高于非FSH瘤者（P〈0．05），受试者工作特征（ROC）曲线得出诊断FSH瘤术前FSH水平的切点值是6．685m IU／ml。裸细胞腺瘤侵袭性最高（86．2％），但各组问差异无统计学意义（P〉0．05）。各组肿瘤侵袭性与术前催乳素及生长激素水平、肿瘤大小、年龄及BMI均无相关性（P〉0．05）。术后5种类型的缓解率分别为65．2％、61．1％、50．0％、76．9％及45．5％。结论育龄期女性少见垂体腺瘤的类型和临床特征与一般人群不尽相同。术前催乳素水平对鉴别5种类型肿瘤有一定价值，随机ACTH水平对ACTH腺瘤诊断无价值；随机FSH水平〉6．685mIU／nd对FSH瘤的诊断有一定价值；裸细胞瘤侵袭性比例最高。Objective To investigate the distribution of age and tumor size, clinical symptoms, imaging, hormone levels, pathology and prognosis in reproductive age female with rare pituitary adenomas. Methods We analysed and followed up the clinical data of 120 cases of 15-50 years females with rare pituitary adenomas. Results In reproductive age females, rare pituitary adenomas were prolactin（PRL） ＋ growth hormone （GH） adenomas （ 25.8 % ） , null cell adenomas （ 24.2% ） , adrenocorticotropic hormone （ACTH） adcnomas （ 19. 0% ） , plurihormonal pituitary adenomas （ 15. 8% ） and follicle stimulating hormone（FSH） adenomas（ 15.2% ）. The majority of tumors were maeroadenomas. Prolactin levels were high in all rare pituitary adenomas. Median prolaetin level were 98.18 μg/L,30.83μg/L,33.14μg/L, 61.50 μg/L and 78.82 μg/L, respectively. Most of ACTH adenomas were silent corticotroph adenomas. Preoperative ACTH level was not related with pathology result （P 〉 0. 05 ）. Compared with non-FSH adenomas, preoperative FSH level was higher in FSH adenomas（ P 〈 0.05 ）. According to ROC, diagnostic cut-off Value of preoperative FSH level was 6. 685 mIU/ml. In rare pituitary adenomas ,null cell adcnomas was the most aggressive （86.2%）. However, invasiveness of tumor was not statistical difference among several rare pituitary adenomas and not related with preoperative PRL level, GH level, tumor size, age and BMI in the same pituitary adenomas types（P 〉 0.05 ）. Remission rate in five different kinds of pituitary adenomas were 65.2% , 61. 1% ,50% , 76.9% and 45.5% , respectively. Conclusion Compared with general population,clinical features of rare pituitary adenomas of reproductive age female were not completely equivalent. Preoperative PRL level is useful for differential diagnosis among several rare pituitary adenomas to some extent. Random ACTH levels arc worthless to ACTH adenomas. When preoperative FSH level is above 6. 685 mIU/mL, it was significant to diagnose FSH adenomas. N

关 键 词：育龄期女性 少见 垂体腺瘤 临床特征 

分 类 号：R737.901[医药卫生—肿瘤]