Zhou Heping, Zha Zhengjiang, Li Xiangdong, Chen Xinsheng, Wang Jing, Su Zhongzhou
Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Soochow, 215006, Jiangsu Province, People's Republic of China.
Department of Neurosurgery, Anqing Affiliated Hospital of Anhui Medical University, Anqing, Anhui Province, People's Republic of China.
Neurosurg Rev. 2018 Jul;41(3):869-875. doi: 10.1007/s10143-017-0936-7. Epub 2017 Dec 13.
The study aimed to retrospectively analyze the clinical characteristics of patients with pituitary adenomas complicated by acromegalic cardiomyopathy and to evaluate the effect of endoscopic surgery. Eighty-six pituitary adenoma patients complicated by acromegalic cardiomyopathy who were treated with endoscopic surgery in the First Affiliated Hospital of Soochow University from January 2010 to December 2016 were enrolled. We noted patient clinical characteristics and explored the relationships with surgical treatment. Before and after surgery, all patients underwent an examination of pituitary endocrinology, brain magnetic resonance (MR), and echocardiography. The serum levels of growth hormone (GH), left ventricular end-diastolic diameter (LVIDd), interventricular septal thickness (IVST), left ventricular posterior wall thickness (LVPWT), left ventricular ejection fraction (EF), and mitral valve (E/A ratio) were examined with non-invasive methods, and the results were compared. Of the 86 patients, there were 23 with microadenomas, 27 with large adenomas, and 36 with giant adenomas. There were 28 patients with invasive adenomas and 58 with non-invasive adenomas. The pre-operative mean GH level was 71.23 ± 3.29 μg/L, which was positively correlated with tumor volume (r = 0.751, P < 0.01). Via trans-sphenoidal endoscopic pituitary adenoma resection, 51 patients underwent total tumor resections, 25 underwent subtotal resections, 8 underwent major part resections, and 2 underwent partial resections. After surgery, the GH mean level was 3.81 ± 1.03 μg/L, which was significantly different (t = 3.72, P < 0.01) from the pre-operative level. Cardiac function indices, including LVIDd, IVST, LVPWT, E/A, and EF, were significantly improved. The long-term curative rate was 39.17% and the remission rate was 77.29%. For pituitary adenoma patients complicated by acromegalic cardiomyopathy, endoscopic surgery resulted in a good curative effect and the growth hormone levels were maintained, which can significantly improve cardiac structure and function.
本研究旨在回顾性分析垂体腺瘤合并肢端肥大性心肌病患者的临床特征，并评估内镜手术的效果。选取2010年1月至2016年12月在苏州大学附属第一医院接受内镜手术治疗的86例垂体腺瘤合并肢端肥大性心肌病患者。记录患者的临床特征，并探讨其与手术治疗的关系。手术前后，所有患者均接受垂体内分泌检查、脑部磁共振成像（MR）和超声心动图检查。采用无创方法检测血清生长激素（GH）水平、左心室舒张末期内径（LVIDd）、室间隔厚度（IVST）、左心室后壁厚度（LVPWT）、左心室射血分数（EF）和二尖瓣（E/A比值），并比较结果。86例患者中，微腺瘤23例，大腺瘤27例，巨大腺瘤36例。侵袭性腺瘤28例，非侵袭性腺瘤58例。术前平均GH水平为71.23±3.29μg/L，与肿瘤体积呈正相关（r=0.751，P<0.01）。经蝶窦内镜垂体腺瘤切除术，51例患者肿瘤全切，25例次全切除，8例大部分切除，2例部分切除。术后GH平均水平为3.81±1.03μg/L，与术前水平相比差异有统计学意义（t=3.72，P<0.01）。包括LVIDd、IVST、LVPWT、E/A和EF在内的心脏功能指标显著改善。长期治愈率为39.17%，缓解率为77.29%。对于垂体腺瘤合并肢端肥大性心肌病患者，内镜手术疗效良好，生长激素水平得到控制，可显著改善心脏结构和功能。
