Marek J, Malík J, Fendrych P
III. interní klinika 1. LF UK a VFN, Praha.
Cas Lek Cesk. 1995 Sep 6;134(17):543-6.
Surgery of pituitary adenomas is not quite satisfactory so far and in some patients it is associated with a high risk. Conventional radiotherapy is only partly successful. Only few hospitals have experience with treatment of pituitary adenomas with Leksell's gamma knife. The objective of the presented paper is to give an account of the authors' own results of treatment of pituitary adenomas by irradiation with Leksell's gamma knife.
The treated group comprised 13 patients (6 women, 7 men, 25-72 years old, median 44 years) with a pituitary adenoma. Hormonally active acromegaly was recorded in 9 patients, a prolactinoma in one female patient, afunctional adenoma in 3 patients. Twelve patients had been operated already previously, 3 of them twice. For visualization of the pituitary magnetic resonance (NMR) was used on a Magnetom apparatus 1.5 Tesla, Siemens Co. before surgery and one year after surgery. As hormonal indicators the following were examined: growth hormone (GH) profile in the course of the day and during the thyroliberin test (TRH), insulin-like growth factor I (IGF I), the prolactin level, the thyrotropin level (TSH) during the thyrotropin releasing hormone test (TRH) test the thyroxine level (T4) and the triiodothyronine level (T3), the plasma concentration of adrenocorticotropin (ACTH), the cortisol level, plasma testosterone level and 17-beta estradiol level. Complete recovery was achieved only in one female patient with acromegaly 18 months after irradiation, and in one patient with a prolactinoma a partial decline of hormone levels was recorded without detectable changes in the size of the adenoma. Only one female patient developed hypopituitarism. No other complications were recorded.
Stereotactic irradiation with Leksell's gamma knife is valuable for treatment of pituitary adenomas and it is well tolerated therapy. Its effect is manifested only after several months. Complications in the sense of hypopituitarism may occur.
目前垂体腺瘤手术效果尚不尽人意，部分患者手术风险较高。传统放疗仅部分有效。仅有少数医院有使用Leksell伽马刀治疗垂体腺瘤的经验。本文目的是阐述作者使用Leksell伽马刀照射治疗垂体腺瘤的自身结果。
治疗组包括13例垂体腺瘤患者（6例女性，7例男性，年龄25 - 72岁，中位年龄44岁）。9例患者为有激素活性的肢端肥大症，1例女性患者为泌乳素瘤，3例患者为无功能腺瘤。12例患者此前已接受过手术，其中3例接受过两次手术。术前及术后1年，使用西门子公司1.5特斯拉的Magnetom设备进行垂体磁共振成像（NMR）以进行可视化。作为激素指标，检测了以下各项：一天中及促甲状腺素释放激素试验（TRH）期间的生长激素（GH）谱、胰岛素样生长因子I（IGF I）、泌乳素水平、促甲状腺素释放激素试验（TRH）期间的促甲状腺素水平（TSH）、甲状腺素水平（T4）和三碘甲状腺原氨酸水平（T3）、促肾上腺皮质激素（ACTH）的血浆浓度、皮质醇水平、血浆睾酮水平和17-β雌二醇水平。仅1例肢端肥大症女性患者在照射后18个月实现完全康复，1例泌乳素瘤患者激素水平部分下降，但腺瘤大小无明显变化。仅1例女性患者出现垂体功能减退。未记录到其他并发症。
Leksell伽马刀立体定向照射对垂体腺瘤治疗有价值，且耐受性良好。其效果在数月后才显现。可能会出现垂体功能减退意义上的并发症。
