垂体腺瘤梗塞型卒中患者术前内分泌学特征初探  

Preoperative endocrinological characteristics of pituitary apoplexy of infarcted type

作　　者：尹宏伟 李卓群 王宇翔 李环廷[2] 丰育功[2] 李照建[2] Yin Hongwei;Li Zhuoqun;Wang Yuxiang;Li Huantin;Feng Yugong;Li Zhaojian(Department of Medicine,Qingdao University,Qingdao 266000,China;Department of Neurosurgery,Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学医学部,青岛266000 [2]青岛大学附属医院神经外科,青岛266000

出　　处：《中华神经医学杂志》2020年第6期552-556,共5页Chinese Journal of Neuromedicine

摘　　要：目的探究垂体腺瘤梗塞型卒中患者术前的内分泌学特征。方法对青岛大学附属医院神经外科自2010年1月至2019年10月收治的、经术后病理证实为垂体腺瘤梗塞型卒中的26例患者,在术前进行垂体腺瘤卒中评分,并对垂体3个靶腺轴即垂体-甲状腺轴、垂体-性腺轴、垂体-肾上腺轴进行内分泌检查,以评估垂体功能和靶腺轴功能。结果患者术前垂体腺瘤卒中评分(1.92±1.78)分,范围为2~8分。腺垂体功能受损患者25例(96%),其中全垂体功能低下13例,部分垂体功能低下12例(2个靶腺轴受累9例,1个靶腺轴受累3例)。存在垂体-性腺轴功能低下22例(85%),垂体-甲状腺轴功能低下14例(54%),垂体-肾上腺轴功能低下13例(50%)。患者术前泌乳素(PRL)降低26例(100%)、睾酮(T)降低26例(100%)、促黄体生成素(LH)降低18例(75%)、孕激素(P)降低18例(75%)、促甲状腺激素(TSH)降低18例(69%)、游离三碘甲状腺原氨酸(FT3)降低17例(65%)、游离甲状腺素(FT4)降低14例(54%)、雌二醇(E2)降低13例(54%)、皮质醇(CORT)降低13例(52%)、促卵泡生成素(FSH)降低9例(38%)、促肾上腺皮质激素(ACTH)降低9例(35%)、生长激素(GH)降低3例(15%)。结论垂体腺瘤梗塞型卒中最常发生垂体-性腺轴功能低下,其内分泌学特点为患者术前PRL和T水平的急剧下降。Objective To investigate the preoperative endocrinological characteristics of pituitary apoplexy of infarcted type.Methods Twenty-six patients with pituitary apoplexy of infarcted type,confirmed by pathological pathology in our hospital from January 2010 to October 2019,were chosen.All patients were performed pituitary adenoma stroke scale before surgery,and endocrine examinations were performed on three pituitary target gland axes,namely the pituitary-thyroid axis,pituitary-gonadal axis and pituitary-adrenal axis,to evaluate the pituitary function and functions of three target gland axes.Results Preoperative pituitary adenoma stroke scale scores were(1.92±1.78),ranged from 2 to 8.Twenty-five patients(96%)were with impaired pituitary function,including 13 patients(50%)with panhypopituitarism and 12 patients(46%)with partial hypopituitarism;in these 12 patients with partial hypopituitarism,9 patients were noted to be involved two target gland axes,and 3 patients were noted to be involved one target gland axis.There were 22 patients(85%)with hypophysia-gonadal axis hypopituitarism,14(54%)with hypophysia-thyroid axis hypopituitarism,and 13(50%)with hypophysia-adrenal axis hypopituitarism.Preoperative levels of prolactin in 26 patients(100%),testosterone in 26 patients(100%),luteinizing hormone in 18 patients(75%),progestational hormone in 18 patients(75%),thyroid stimulating hormone in 18 patients(69%),free triiodothyronine in 17 patients(65%),free thyroxine in 14 patients(54%),estradiol in 13 patients(54%),cortisol in 13 patients(52%),follicle stimulating hormone in 9 patients(38%),adrenocorticotrophic hormone in 9 patients(35%),growth hormone in 3 patients(15%)were lower as compared with baseline levels.Conclusion Hypophysia-gonadal axis hypopituitarism is most common in pituitary apoplexy of infarcted type,and the endocrinological features are the sharp decrease of prolactin and testosterone levels.

关 键 词：垂体腺瘤 梗塞型卒中 内分泌学 泌乳素 睾酮 

分 类 号：R736.4[医药卫生—肿瘤]