Arita K, Uozumi T, Yano T, Kurisu K, Hirohata T, Eguchi K, Tominaga A, Pant B, Iida K, Kawamoto H
Department of Neurosurgery, Hiroshima University School of Medicine, Japan.
Endocr J. 1996 Apr;43(2):131-8. doi: 10.1507/endocrj.43.131.
The effects of surgery on pituitary-gonadal function were investigated in women with pituitary adenomas other than prolactinomas. The subjects were 46 women of premenopausal age with a pituitary adenoma. Twenty tumors were GH producing, 19 were nonfunctioning, and 7 were adrenocorticotropin producing adenomas. The surgery was performed mainly via the transsphenoidal route, with the aim of eradicating the tumor and preserving pituitary function. The menstrual cycle was preserved postoperatively in 9 out of 10 (90%) patients with regular preoperative menstruation. Menstrual disturbance was seen in 36 (78.3%) cases preoperatively. The causative factors for menstrual disturbance were gonadotropin impairment and hyperprolactinemia in GH producing and nonfunctioning adenoma. Excessive hormonal secretion itself is a major causative factor for menstrual disturbance in GH and ACTH producing adenoma. Regular menstruation was restored following surgery in 20 out of 36 (55.6%) patients with menstrual problems. The predicting factors for postoperative recovery of menstruation are: size of adenoma less than 40 mm, period of amenorrhea less than 5 years, and preoperatively preserved gonadotropin secretion. In addition, preoperative hyperprolactinemia was also a predicting factor in women with nonfunctioning adenoma. Thus, even in patients with pituitary adenomas other than prolactinoma, the restoration of menstruation is highly achievable when surgery is performed with attention to preserving pituitary function.
在患有除催乳素瘤以外的垂体腺瘤的女性中，研究了手术对垂体 - 性腺功能的影响。研究对象为46名绝经前年龄的垂体腺瘤女性。其中20个肿瘤分泌生长激素，19个无功能，7个为分泌促肾上腺皮质激素的腺瘤。手术主要通过经蝶窦途径进行，目的是根除肿瘤并保留垂体功能。术前月经规律的10名患者中，有9名（90%）术后月经周期得以保留。术前有36例（78.3%）出现月经紊乱。生长激素分泌型和无功能腺瘤导致月经紊乱的原因是促性腺激素受损和高催乳素血症。激素分泌过多本身是生长激素和促肾上腺皮质激素分泌型腺瘤月经紊乱的主要原因。36例有月经问题的患者中，20例（55.6%）术后月经恢复正常。术后月经恢复的预测因素为：腺瘤大小小于40毫米、闭经时间小于5年以及术前促性腺激素分泌保留。此外，术前高催乳素血症也是无功能腺瘤女性的一个预测因素。因此，即使在患有除催乳素瘤以外的垂体腺瘤的患者中，在手术时注意保留垂体功能的情况下，月经恢复的可能性也很高。
