Inder W J, Espiner E A, MacFarlane M R
Department of Endocrinology, Christchurch Hospital, Christchurch, New Zealand.
Intern Med J. 2003 Apr;33(4):168-73. doi: 10.1046/j.1445-5994.2003.00348.x.
Recent evidence has highlighted the importance of the neurosurgeon in the management of secretory pituitary tumours, but most reports are from major centres.
To audit the surgical outcome of patients with acromegaly and Cushing's disease treated in a small centre (Christchurch, New Zealand) by a dedicated neurosurgeon with an interest in pituitary disease, and follow-up through an outpatient Department of Endocrinology.
All cases of acromegaly and Cushing's disease admitted for surgery in Christchurch Hospital between 1984 and 2000 were audited. Data concerning preoperative findings, surgical remission rate, complications and follow-up were obtained from 44 patients (28 acromegaly, 16 Cushing's disease).
Of the 28 acromegalic patients, 14 patients (50%) had a mean growth hormone level <2.5 micro g/L within the first postoperative week. Of the 15 Cushing's disease patients in whom the pituitary fossa was explored, 13 patients (87%) entered a postoperative remission, defined as an 08.00 h cortisol <200 nmol/L (normal range 250-800 nmol/L). No perioperative deaths occurred. Two of the 43 patients (4.7%) developed permanent diabetes insipidus, while eight of the 28 patients who were operated on for acromegaly (29%) eventually required some replacement treatment for hypopituitarism during follow-up (one presented with apoplexy and seven were treated with postoperative radiotherapy).
In a small centre with a dedicated pituitary surgeon, operative remission rates approach those obtained in larger, more specialized centres. However, given New Zealand's small, but geographically spread population, consideration should be given to establishing one or two units for the surgical management of secretory pituitary adenomas.
近期证据凸显了神经外科医生在分泌性垂体瘤管理中的重要性，但大多数报告来自大型中心。
审核在一个小型中心（新西兰克赖斯特彻奇）由一位对垂体疾病感兴趣的专业神经外科医生治疗的肢端肥大症和库欣病患者的手术结果，并通过内分泌科门诊进行随访。
对1984年至2000年间在克赖斯特彻奇医院因手术入院的所有肢端肥大症和库欣病病例进行审核。从44例患者（28例肢端肥大症，16例库欣病）获取有关术前检查结果、手术缓解率、并发症及随访的数据。
28例肢端肥大症患者中，14例（50%）在术后第一周平均生长激素水平<2.5μg/L。在15例探查垂体窝的库欣病患者中，13例（87%）术后进入缓解期，缓解定义为上午8点皮质醇<200nmol/L（正常范围250 - 800nmol/L）。未发生围手术期死亡。43例患者中有2例（4.7%）发生永久性尿崩症，而28例接受肢端肥大症手术的患者中有8例（29%）在随访期间最终需要某种垂体功能减退替代治疗（1例发生卒中，7例接受术后放疗）。
在有专业垂体外科医生的小型中心，手术缓解率接近大型、更专业中心所取得的缓解率。然而，鉴于新西兰人口少但地域分散，应考虑设立一两个单位用于分泌性垂体腺瘤的外科治疗。
