Hurley David M, Ho Ken K Y
Department of Endocrinology and Diabetes, Royal Perth Hospital, Wellington Street Campus, Box X2213, GPO, Perth, WA 6847, Australia.
Med J Aust. 2004 Apr 19;180(8):419-25.
Pituitary adenomas are found in 10%-25% of unselected autopsy series and are evident in about 10% of asymptomatic individuals by magnetic resonance imaging. Diagnosis of pituitary disorders is often delayed by lack of awareness and the subtlety of symptoms and signs. Hypopituitarism is suspected when peripheral hormone concentrations are low without an elevation in the corresponding pituitary tropic hormone(s). Severe adult-onset growth-hormone deficiency results in reduced muscle mass, increased fat mass and diminished quality of life, which are reversed by growth hormone replacement therapy. While trans-sphenoidal surgery remains first-line treatment for acromegaly, drug treatment has an important role in controlling residual growth-hormone excess and, in some circumstances, as first-line treatment. Dopamine-agonist therapy (cabergoline or bromocriptine) is the treatment of choice for micro- and macroprolactinomas. In patients with suggestive clinical features, elevated 24-hour urine free cortisol level is usually sufficient to diagnose endogenous Cushing's syndrome; careful additional investigation is needed to determine whether the cause is Cushing's disease (pituitary adenoma secreting adrenocorticotropic hormone [ACTH]), ectopic ACTH secretion or adrenal disease. Heightened awareness is needed to detect the sometimes subtle symptoms and signs of pituitary disease
在未经筛选的尸检系列中，垂体腺瘤的发现率为10% - 25%，在约10%的无症状个体中，磁共振成像可显示垂体腺瘤。由于缺乏认识以及症状和体征不明显，垂体疾病的诊断常常被延误。当外周激素浓度较低而相应的垂体促激素没有升高时，怀疑存在垂体功能减退。严重的成人起病型生长激素缺乏会导致肌肉量减少、脂肪量增加和生活质量下降，而生长激素替代疗法可逆转这些情况。虽然经蝶窦手术仍然是肢端肥大症的一线治疗方法，但药物治疗在控制残余的生长激素过多方面具有重要作用，在某些情况下也可作为一线治疗。多巴胺激动剂疗法（卡麦角林或溴隐亭）是微泌乳素瘤和大泌乳素瘤的首选治疗方法。对于具有提示性临床特征的患者，24小时尿游离皮质醇水平升高通常足以诊断内源性库欣综合征；需要进行仔细的进一步检查以确定病因是库欣病（分泌促肾上腺皮质激素[ACTH]的垂体腺瘤）、异位ACTH分泌还是肾上腺疾病。需要提高认识以检测垂体疾病有时不明显的症状和体征。
