Arafah B M, Kailani S H, Nekl K E, Gold R S, Selman W R
Division of Clinical and Molecular Endocrinology, Case Western Reserve University School of Medicine, Cleveland, Ohio.
J Clin Endocrinol Metab. 1994 Aug;79(2):348-54. doi: 10.1210/jcem.79.2.8045946.
Mild hyperprolactinemia frequently accompanies the hypopituitarism associated with pituitary macroadenomas not secreting PRL. Because of this association, hypopituitarism was postulated to be due to compression of portal vessels. We postulate that resumption of hypothalamic control over pituitary function occurs immediately after adenomectomy. To test this hypothesis, we examined pituitary function before and after transsphenoidal adenomectomy in 26 ACTH-deficient patients and 23 subjects with normal adrenal and thyroidal functions (control group). Glucocorticoids, given only to ACTH-deficient subjects, were withdrawn 36 h after surgery. ACTH, cortisol, and PRL levels were measured twice daily in all patients. Both ACTH and PRL levels increased hours after surgery in controls and returned to baseline over 4 days. In all hypopituitary subjects, PRL levels decreased by 50% within hours of adenomectomy and remained so until discharge. ACTH levels, measured simultaneously, increased within hours in 17 of 26 hypopituitary patients, all of whom recovered normal adrenal function before discharge. Nine additional patients had low ACTH levels and required cortisol replacement. The reciprocal changes in PRL and ACTH levels measured simultaneously, hours after surgery, support the hypothesis that hypopituitarism is reversible and largely caused by compression of the protal vessels and the resulting interruption of delivery of hypothalamic hormones. The persistence of hypopituitarism in some patients suggests that ischemic necrosis of the anterior pituitary could limit recovery.
轻度高泌乳素血症常伴随与不分泌泌乳素的垂体大腺瘤相关的垂体功能减退。由于这种关联，垂体功能减退被推测是由于门静脉受压所致。我们推测，垂体腺瘤切除术后下丘脑对垂体功能的控制立即恢复。为了验证这一假设，我们对26例促肾上腺皮质激素（ACTH）缺乏患者和23例肾上腺及甲状腺功能正常的受试者（对照组）进行了经蝶窦垂体腺瘤切除术前后的垂体功能检查。仅对ACTH缺乏的受试者给予糖皮质激素，术后36小时停用。所有患者每天测量两次ACTH、皮质醇和泌乳素水平。对照组术后数小时ACTH和泌乳素水平均升高，并在4天内恢复至基线水平。在所有垂体功能减退的受试者中，泌乳素水平在垂体腺瘤切除术后数小时内下降50%，并一直保持至出院。同时测量的ACTH水平，在26例垂体功能减退患者中有17例在数小时内升高，所有这些患者在出院前肾上腺功能均恢复正常。另外9例患者ACTH水平较低，需要补充皮质醇。术后数小时同时测量的泌乳素和ACTH水平的相反变化支持了以下假设：垂体功能减退是可逆的，主要是由门静脉受压以及由此导致的下丘脑激素输送中断引起的。一些患者垂体功能减退持续存在，提示垂体前叶缺血坏死可能会限制恢复。
