Ono Erina, Ozawa Ayako, Matoba Kaori, Motoki Takanori, Tajima Asako, Miyata Ichiro, Ito Junko, Inoshita Naoko, Yamada Syozo, Ida Hiroyuki
Department of Pediatrics, The Jikei University School of Medicine, Tokyo, Japan.
Clin Pediatr Endocrinol. 2011 Oct;20(4):89-93. doi: 10.1297/cpe.20.89. Epub 2011 Nov 15.
It is sometimes difficult to confirm the location of a microadenoma in Cushing disease. Recently, we experienced an 11-yr-old female case of Cushing disease with hyperprolactinemia. She was referred to our hospital because of decrease of height velocity with body weight gain. On admission, she had typical symptoms of Cushing syndrome. Although no pituitary microadenomas were detected on 1.5 Tesla MRI of the brain, endocrinological examinations including IPS and CS sampling were consistent with Cushing disease with hyperprolactinemia. Oral administration of methyrapone instead of neurosurgery was started after discharge, but subsequent 3 Tesla MRI of the brain clearly demonstrated a 3-mm less-enhanced lesion in the left side of the pituitary gland. Finally, transsphenoidal surgery was performed, and a 3.5-mm left-sided microadenoma was resected. Compared with 1.5 Tesla MRI, 3 Tesla MRI offers the advantage of a higher signal to noise ratio (SNR), which provides higher resolution and proper image quality. Therefore, 3 Tesla MRI is a very useful tool to localize microadenomas in Cushing disease in children as well as in adults. It will be the first choice of radiological examinations in suspected cases of Cushing disease.
在库欣病中，有时很难确定微腺瘤的位置。最近，我们遇到一例11岁患有高催乳素血症的库欣病女性病例。她因身高增长速度减慢伴体重增加而被转诊至我院。入院时，她有典型的库欣综合征症状。尽管脑部1.5特斯拉磁共振成像（MRI）未检测到垂体微腺瘤，但包括岩下窦采样（IPS）和外周血采样（CS）在内的内分泌检查结果与伴有高催乳素血症的库欣病相符。出院后开始口服甲吡酮而非进行神经外科手术，但随后的脑部3特斯拉MRI清楚地显示垂体左侧有一个3毫米强化减弱的病灶。最后，进行了经蝶窦手术，切除了一个3.5毫米的左侧微腺瘤。与1.5特斯拉MRI相比，3特斯拉MRI具有更高的信噪比（SNR），能提供更高的分辨率和合适的图像质量。因此，3特斯拉MRI是定位儿童及成人库欣病微腺瘤的非常有用的工具。在疑似库欣病的病例中，它将成为放射学检查的首选。
