垂体腺瘤患者围术期糖皮质激素替代疗法的研究进展及争议  

Perioperative Glucocorticoid Replacement Therapy in Patients with Pituitary Adenomas:Research Progress and Controversies

作　　者：郭晓鹏 幸兵 连伟 马文斌 GUO Xiaopeng;XING Bing;LIAN Wei;MA Wenbin(Department of Neurosurgery,Chinese Academy of Medical Sciences/Peking Union Medical College/Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院北京协和医院神经外科,北京市100730

出　　处：《实用心脑肺血管病杂志》2022年第2期103-106,共4页Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease

基　　金：教育部产学合作协同育人项目(202002277001)。

摘　　要：垂体腺瘤是第二位常见的原发性中枢神经系统肿瘤,糖皮质激素常作为垂体腺瘤患者围术期常规替代治疗药物,用以预防术后肾上腺皮质功能低下或肾上腺危象发生。但近年随着临床对糖皮质激素不良反应认识程度的加深、对患者围术期激素动态变化研究的深入,并结合既往研究,使垂体腺瘤患者围术期常规给予糖皮质激素替代治疗的做法受到质疑。本文就垂体腺瘤患者围术期应用糖皮质激素的最新研究进展进行综述,得出对于促肾上腺皮质激素腺瘤及术前合并肾上腺皮质功能低下的垂体腺瘤患者,需在围术期应用糖皮质激素替代治疗。但针对下丘脑-垂体-肾上腺(HPA)轴功能正常的垂体腺瘤患者围术期是否必须应用糖皮质激素仍在讨论中,且尚缺乏指南对此进行明确指示。Pituitary adenomas(PAs)are the second most common primary central nervous system tumors.Perioperative replacement therapy with glucocorticoid has long been used for patients with PAs,in order to prevent postoperative adrenal insufficiency or adrenal crisis.In recent years,with the deepening of clinical understanding of adverse reactions of glucocorticoids,the in-depth study of hormone dynamic changes in patients during perioperative period,combined with previous studies,the practice of routinely giving glucocorticoid replacement therapy to patients with pituitary adenoma during perioperative period has been questioned.In this review,we summarize the research progress on perioperative glucocorticoid replacement therapy in patients with PAs.There is consensus that perioperative replacement therapy with glucocorticoid should be used in the patients with adrenocorticotropic hormone adenomas and PAs with preoperative adrenal insufficiency.However,the necessity of routine use of perioperative glucocorticoids in patients with normal hypothalamic-pituitary-adrenal(HPA)axis is still on discussion,and there is still a lack of clinical guidance on this issue.

关 键 词：垂体腺瘤 糖皮质激素 肾上腺皮质功能低下 肾上腺危象 下丘脑-垂体-肾上腺轴 

分 类 号：R651.13[医药卫生—外科学] R584[医药卫生—临床医学]