Saeki N, Sunada S, Tokunaga H, Hoshi S, Sunami K, Terano T, Yamaura A
Department of Neurological Surgery, Chiba University School of Medicine, Japan.
J Clin Neurosci. 2000 Mar;7(2):146-7. doi: 10.1054/jocn.1999.0169.
A 58 year old man showed acromegalic features. The serum growth hormone (GH) level was 7.3 ng/ml and SMC (somatomedin-C) 637 U/ml. Triple stimulation test showed abnormal response compatible with a GH secreting tumour. The conventional enhanced MRI revealed a less enhanced hemisphere-shaped lesion at the right corner of the sella turcica. In addition, dynamic MRI demonstrated an elongated lesion extending to the left beyond the midline. The patient underwent transsphenoidal surgery. Besides the soft and suckable tumour at the right corner, we entered into a small cavity loosely filled with the tumour, which was subsequently also removed. The operative finding corresponded to the lesion shown in dynamic MRI. Postoperative GH and SMC levels became 2.3 ng/ml and 326 U/ml respectively. Incidental pituitary cystic lesions in autopsied cases have been reported to be 6-33%. This case had a GH secreting adenoma with coexisting pituitary cyst. The coexisting pituitary cyst supposedly influenced the unusual shape and extension of the pituitary adenoma. Coexistence of such lesion should be kept in mind for microadenoma on neuroradiological evaluation and on intraoperative inspection surrounding the tumour.
一名58岁男性表现出肢端肥大症特征。血清生长激素（GH）水平为7.3 ng/ml，胰岛素样生长因子C（SMC）为637 U/ml。三联刺激试验显示异常反应，符合生长激素分泌性肿瘤。传统增强磁共振成像（MRI）显示蝶鞍右角有一个强化程度较低的半球形病变。此外，动态MRI显示一个细长病变向左延伸至中线以外。患者接受了经蝶窦手术。除了蝶鞍右角柔软且可吸出的肿瘤外，我们进入了一个小腔隙，腔内松散地充满肿瘤，随后也将其切除。手术所见与动态MRI所示病变相符。术后GH和SMC水平分别变为2.3 ng/ml和326 U/ml。据报道，尸检病例中偶然发现的垂体囊性病变为6% - 33%。该病例为生长激素分泌性腺瘤合并垂体囊肿。共存的垂体囊肿可能影响了垂体腺瘤的异常形状和延伸。在对微腺瘤进行神经放射学评估以及术中检查肿瘤周围情况时，应考虑到这种病变的共存。
