Doppman J L, Miller D L, Patronas N J, Oldfield E H, Merriam G R, Frank S J, Flack M R, Weintraub B D, Gorden P
Department of Diagnostic Radiology, Warren G. Magnuson Clinical Center, National Institutes of Health, Bethesda, MD 20892.
AJR Am J Roentgenol. 1990 May;154(5):1075-7. doi: 10.2214/ajr.154.5.2108545.
The early diagnosis of acromegaly may be difficult when serum levels of growth hormone are minimally elevated and imaging of the pituitary gland fails to show an adenoma. However, transsphenoidal surgery has the greatest chance of cure at this stage. We therefore investigated the value of sampling petrosal sinuses for measurement of growth hormone in this group of patients. Simultaneous bilateral sampling of the inferior petrosal sinuses to measure serum concentrations of growth hormone was performed in five patients suspected of having acromegaly but with nondiagnostic CT scans (n = 5) and MR images (n = 3) of the pituitary gland. Levels of growth hormone from the petrosal sinuses were five to 36 times greater than levels in the peripheral veins in all five patients, and three of four showed a marked response to growth hormone-releasing hormone. During transsphenoidal surgery, growth hormone-producing microadenomas were resected completely in four patients. In the fifth patient, a left-sided microadenoma had invaded the cavernous sinus and could not be resected completely. Lateralization of the adenomas within the pituitary gland on the basis of differences in levels of growth hormone between the two petrosal sinuses was not completely reliable. Elevated levels of growth hormone in selective samples from the inferior petrosal sinuses can help support an early diagnosis of acromegaly when peripheral growth hormone levels and imaging are not diagnostic.
当生长激素的血清水平仅轻微升高且垂体成像未显示腺瘤时，肢端肥大症的早期诊断可能会很困难。然而，经蝶窦手术在这个阶段治愈的机会最大。因此，我们研究了在这类患者中采集岩下窦样本以测量生长激素的价值。对5例疑似肢端肥大症但垂体CT扫描（n = 5）和MRI图像（n = 3）未明确诊断的患者进行了双侧同时采集岩下窦样本以测量生长激素的血清浓度。所有5例患者岩下窦的生长激素水平比外周静脉中的水平高5至36倍，4例中有3例对生长激素释放激素有明显反应。在经蝶窦手术中，4例患者的生长激素分泌微腺瘤被完全切除。在第5例患者中，左侧微腺瘤侵犯海绵窦，无法完全切除。根据两个岩下窦生长激素水平的差异来确定垂体腺体内腺瘤的侧别并不完全可靠。当外周生长激素水平和成像未明确诊断时，岩下窦选择性样本中生长激素水平升高有助于支持肢端肥大症的早期诊断。
