Pittman H H, Dugger G S, Banerjee T
South Med J. 1977 Nov;70(11):1322-4. doi: 10.1097/00007611-197711000-00024.
The presenting signs, symptoms, roentgenographic findings, endocrine evaluations, treatment, and results in 68 cases of presumed pituitary adenomas treated over an 18-year period are discussed. The most common symptoms were headache, acromegalic changes, visual symptoms, and amenorrhea. Most common physical findings were obesity, acromegaly, and visual field defects, usually bitemporal hemianopsia. Roentgenographic evidence of sellar erosion was almost universal but angiography and pneumoencephalography were required to evaluate suprasellar extension. Brain scan was not considered a particularly useful diagnostic tool. Endocrine status was best evaluated by a battery of tests including 17-OH, 17-KS, T3, T4, PBI, ACTH stimulation, and FSH and STH levels. (Prolactin levels are currently being obtained, also). Surgical specimens were obtained in 29 patients, with subsequent diagnoses of 22 chromophobe adenomas, five eosinophilie adenomas, one cystic adenoma, and one necrotic tumor. All five eosinophilic tumors came from acromegalic patients. Patients treated by operation alone or operation followed by radiotherapy generally had less "medical morbidity" than did patients who received radiotherapy alone.
本文讨论了18年间治疗的68例疑似垂体腺瘤患者的临床表现、症状、X线检查结果、内分泌评估、治疗方法及治疗结果。最常见的症状为头痛、肢端肥大症改变、视觉症状及闭经。最常见的体格检查发现为肥胖、肢端肥大症及视野缺损，通常为双颞侧偏盲。蝶鞍侵蚀的X线证据几乎普遍存在，但需行血管造影和气脑造影以评估鞍上扩展情况。脑扫描不被认为是一种特别有用的诊断工具。通过一系列检查，包括17-OH、17-KS、T3、T4、PBI、促肾上腺皮质激素刺激试验以及促卵泡激素和生长激素水平，可最佳地评估内分泌状态。（目前也在检测催乳素水平）。29例患者获得了手术标本，随后诊断出22例嫌色细胞瘤、5例嗜酸性细胞瘤、1例囊性腺瘤和1例坏死肿瘤。所有5例嗜酸性肿瘤均来自肢端肥大症患者。单纯接受手术治疗或手术加放疗的患者，其“医疗并发症”通常比单纯接受放疗的患者少。
