Young W F, Scheithauer B W, Kovacs K T, Horvath E, Davis D H, Randall R V
Division of Endocrinology/Metabolism and Internal Medicine, Mayo Clinic Rochester, MN 55905, USA.
Mayo Clin Proc. 1996 Jul;71(7):649-56. doi: 10.1016/S0025-6196(11)63002-4.
To determine the clinical and pathologic features in a large cohort of randomly selected patients with gonadotroph pituitary adenomas.
We retrospectively reviewed clinical, surgical, and pathologic findings in 100 patients (79 men and 21 women, 30 to 82 years old) with this tumor.
Diagnosis of a pituitary tumor was prompted by visual loss (43%), symptoms of hypopituitarism (22%), headache (8%), or a combination of these findings (10%); 17% of the patients were asymptomatic. Visual field defects were present in 68% of the study group, and complete or partial anterior pituitary failure was present in 77%. Serum prolactin concentrations were increased (maximum, 110 ng/mL) in 33% of patients. Hypersecretion of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) was documented in 11 and 5 patients, respectively. The serum level of alpha-subunit was increased in 1 of 29 patients in whom it was measured. All patients had pituitary macroadenomas, only 21% of which were grossly invasive. The surgical approach was transsphenoidal in all but two patients, who underwent transfrontal craniotomy; gross total tumor resection was achieved in 90%. By definition, all tumors had at least 10% immunoreactivity for LH, FSH, or both. All tumors were chromophobic. Ultrastructurally, the tumors were characterized as gonadotroph adenomas of "male" (45%) or "female" (9%) type as well as null-cell adenomas of the oncocytic (35%) or nononcocytic (11%) type. After a median follow-up of 4.3 years, 69% of the patients who had had visual field defects noted normalization or improvement. Persistent or clinically recurrent pituitary tumor tissue was present in 42%. A second pituitary surgical procedure was required in eight patients.
Most patients with clinically evident gonadotroph pituitary tumors have loss of vision and hypopituitarism. Hypersecretion of FSH or LH is unusual, and no distinct hormone-dependent clinical phenotype is present. Transsphenoidal surgical treatment generally yields normalization or improvement of visual field defects.
确定一大组随机选取的促性腺激素垂体腺瘤患者的临床和病理特征。
我们回顾性分析了100例该肿瘤患者（79例男性和21例女性，年龄30至82岁）的临床、手术及病理结果。
垂体瘤的诊断由视力丧失（43%）、垂体功能减退症状（22%）、头痛（8%）或这些表现的组合（10%）引发；17%的患者无症状。68%的研究组患者存在视野缺损，77%存在完全或部分垂体前叶功能减退。33%的患者血清催乳素浓度升高（最高达110 ng/mL）。分别有11例和5例患者记录到促卵泡激素（FSH）和促黄体生成素（LH）分泌过多。在29例检测α亚基血清水平的患者中，有1例升高。所有患者均为垂体大腺瘤，其中仅21%为大体侵袭性。除2例接受经额开颅手术的患者外，所有患者均采用经蝶窦手术入路；90%实现了肿瘤全切。根据定义，所有肿瘤对LH、FSH或两者的免疫反应性至少为10%。所有肿瘤均为嫌色性。超微结构上，肿瘤表现为“男性”（45%）或“女性”（9%）型促性腺激素腺瘤以及嗜酸性（35%）或非嗜酸性（11%）型无细胞瘤。中位随访4.3年后，69%有视野缺损的患者视野恢复正常或改善。42%存在持续性或临床复发性垂体瘤组织。8例患者需要再次进行垂体手术。
大多数有临床症状的促性腺激素垂体瘤患者有视力丧失和垂体功能减退。FSH或LH分泌过多不常见，且不存在明显的激素依赖性临床表型。经蝶窦手术治疗通常可使视野缺损恢复正常或改善。
