[高催乳素血症和肿瘤大小对临床无功能垂体大腺瘤术后垂体功能的影响]

[Influence of hyperprolactinemia and tumoral size in the postoperative pituitary function in clinically nonfunctioning pituitary macroadenomas].

作者信息

Fonseca Ana Luiza Vidal, Chimelli Leila, Santos Mario José C Felippe, Santos Alair Augusto S M Damas dos, Violante Alice Helena Dutra

机构信息

Serviço de Neurocirurgia, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, RJ, Brasil.

出版信息

Arq Neuropsiquiatr. 2002 Sep;60(3-A):590-602.

PMID:12244397

Abstract

OBJECTIVE

To study the influence of hyperprolactinemia and tumoral size in the pituitary function in clinically nonfunctioning pituitary macroadenomas.

METHODS

Twenty three patients with clinically nonfunctioning pituitary macroadenomas were evaluated by image studies (computed tomography or magnetic resonance) and basal hormonal level; 16 had preoperative hypothalamus-hypophysial function tests (megatests). All tumors had histological diagnosis and in seventeen immunohistochemical study for adenohypophysial hormones was also performed. Student's t test, chi square test, exact test of Fisher and Mc Neman test were used for the statistics analysis. The level of significance adopted was 5% (p<0.05).

RESULTS

Tumoral diameter varied of 1.1 to 4.7 cm (average=2.99 cm +/- 1.04). In the preoperative, 5 (21.7%) patients did not show laboratorial hormonal deficit, 9 (39.1%) developed hyperprolactinemia, 13 (56,5%) normal levels of prolactin (PRL) and 1 (4.3%) subnormal; 18 (78.3%) patients developed hypopituitarism (4 pan-hypopituitarism). Nineteen patients (82.6%) underwent transsfenoidal approach, 3 (13%) craniotomy and 1 (4.4%) combined access. Only 6 patients had total tumoral resection. Of the 17 immunohistochemical studies, 5 tumours were immunonegatives, 1 compound, 1 LH+, 1 FSH +, 1 alpha sub-unit and 8 focal or isolated immunorreactivity for one of the pituitary hormones or sub-units; of the other six tumours, 5 were chromophobe and 1 chromophobe/acidophile. No significant statistic difference was noted between tumoral size and preoperative PRL levels (p=0.82), nor between tumoral size and postoperative hormonal state, except in the GH and gonadal axis. Significant statistic was noted: between tumoral size and preoperative hormonal state (except in the gonadal axis); between normal PRL levels, associated to none or little preoperative hypophysial disfunction, and recovery of postoperative pituitary function.

CONCLUSION

Isolated preoperative hyperprolactinemia and tumoral size have not been predictable for the recovery of postoperative pituitary function.

摘要

目的

研究高催乳素血症及肿瘤大小对临床无功能垂体大腺瘤垂体功能的影响。

方法

对23例临床无功能垂体大腺瘤患者进行影像学检查（计算机断层扫描或磁共振成像）及基础激素水平评估；16例患者术前行下丘脑 - 垂体功能试验（大型试验）。所有肿瘤均有组织学诊断，17例还进行了腺垂体激素的免疫组织化学研究。采用学生t检验、卡方检验、Fisher精确检验和Mc Neman检验进行统计学分析。采用的显著性水平为5%（p<0.05）。

结果

肿瘤直径为1.1至4.7厘米（平均 = 2.99厘米±1.04）。术前，5例（21.7%）患者未出现实验室激素缺乏，9例（39.1%）出现高催乳素血症，13例（56.5%）催乳素（PRL）水平正常，1例（4.3%）低于正常水平；18例（78.3%）患者出现垂体功能减退（4例全垂体功能减退）。19例患者（82.6%）接受经蝶窦入路手术，3例（13%）接受开颅手术，1例（4.4%）接受联合入路手术。仅6例患者实现肿瘤全切。在17例免疫组织化学研究中，5例肿瘤为免疫阴性，1例为复合型，1例促黄体生成素阳性，1例促卵泡生成素阳性，1例α亚单位阳性，8例对一种垂体激素或亚单位呈局灶性或孤立性免疫反应；另外6例肿瘤中，5例为嫌色细胞瘤，1例为嫌色/嗜酸细胞瘤。肿瘤大小与术前PRL水平之间未发现显著统计学差异（p = 0.82），肿瘤大小与术后激素状态之间也未发现显著差异，但生长激素和性腺轴除外。发现显著统计学差异：肿瘤大小与术前激素状态之间（性腺轴除外）；正常PRL水平与术前垂体功能无或轻度障碍相关，与术后垂体功能恢复之间。