垂体瘤合并肝硬化患者生长激素反常升高1例  

Abnormal elevation of growth hormone in patients with pituitary adenoma combined with cirrhosis:A case report

作　　者：王燕磊 段敏 肖建中[1] 赵文惠[1] WANG Yanlei;DUAN Min;XIAO Jianzhong;ZHAO Wenhui(Beijing Tsinghua Changgung Hospital,School of Clinical Medicine,Tsinghua University,Beijing 102218,China)

机构地区：[1]清华大学附属北京清华长庚医院,清华大学临床医学院,北京102218

出　　处：《北京大学学报(医学版)》2025年第2期400-402,共3页Journal of Peking University:Health Sciences

摘　　要：垂体瘤是临床的常见疾病,垂体生长激素(growth hormone,GH)瘤导致的肢端肥大症是垂体瘤的主要类型之一。在现有指南中葡萄糖GH抑制试验时GH不能抑制(口服葡萄糖GH抑制试验GH谷值>1μg/L)是诊断GH分泌异常的重要标准[1]。正常情况下GH的分泌受血糖调控,健康人服用葡萄糖后GH受抑制,其谷值<0.4μg/L;垂体GH瘤患者可出现GH水平不受葡萄糖水平的调节,甚至出现GH水平随血糖升高而升高,即GH反常增加(paradoxical increases in GH,PI-GH)。有学者把GH反常增加定义为葡萄糖负荷后前90 min内GH增加20%[2]。The oral glucose growth hormone suppression test is commonly used in the clinical diagnosis of acromegaly,but its results can be influenced by a variety of factors.This case report discusses a patient with a pituitary tumor and concurrent liver cirrhosis,highlighting the complexities in interpreting test results under such conditions.The patient,a 54-year-old male,presented with blurred vision as his primary complaint.Notably,the physical examination revealed no changes in facial features,no enlargement of hands or feet,and no other symptoms typically associated with acromegaly,which might otherwise suggest excessive growth hormone activity.Magnetic Resonance Imaging(MRI)of the pituitary gland indicated that the gland was within normal size parameters,but a small low-intensity lesion mea-suring approximately 3 mm×2 mm identified.This finding was consistent with a pituitary microadenoma.The patient’s fasting growth hormone levels were significantly elevated at 8.470μg/L,compared with the normal range of less than 2.47μg/L.Conversely,fasting insulin-like growth factor-1(IGF-1)levels were notably low,recorded at 41 and 52μg/L,whereas the normal range for a person of his age was between 87 and 234μg/L.Other pituitary hormones,including those regulating the thyroid,adrenal cortex,and sex hormones,were found to be within normal ranges.Despite this,during the glucose growth hormone suppression test,an abnormal elevation of growth hormone was observed.To investigate further,the patient was administered branched-chain amino acids,and the suppression test was repeated.However,the abnormal elevation of growth hormone persisted,indicating a failure to normalize the response.Given the patient’s lack of clinical signs typically associated with elevated growth hormone secretion,the history of liver cirrhosis became a significant consideration.The disparity between elevated growth hormone levels and reduced IGF-1 levels suggested that the pituitary lesion was a non-functional adenoma rather than a source of excess hormo

关 键 词：垂体瘤 肝硬化 葡萄糖生长激素抑制试验 

分 类 号：R736.4[医药卫生—肿瘤] R575.2[医药卫生—临床医学]