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目的分析术后早期未缓解的垂体促肾上腺皮质激素(adrenocorticotropic hormone,ACTH)腺瘤的诊治。方法回顾性分析266例垂体ACTH腺瘤病例资料,均经蝶窦入路手术,其中术后早期内分泌未缓解44例(16.5%)。44例中初发垂体ACTH腺瘤34例(77.3%),复发垂体ACTH腺瘤10例(22.7%);MRI明确显示肿瘤30例(68.2%),MRI阴性14例(31.8%);垂体微腺瘤42例(95.5%),垂体大腺瘤2例(4.5%)。结果术中所取组织经病理检查:垂体腺瘤25例(其中不典型垂体腺瘤3例),垂体增生6例,垂体前叶或后叶13例。术后随访12~36个月,延迟缓解3例,放疗29例(普通放疗25例,伽玛刀4例),拒绝治疗随访观察2例,术后死亡5例,失访5例。在放疗病人中,11例病人血皮质醇恢复正常,2例效果不佳改行双侧肾上腺切除术。结论对经蝶窦入路术后早期未缓解的垂体ACTH腺瘤,随访半年后仍未缓解者,应根据病情行个体化治疗。
Objective To analyze the diagnosis and treatment of adenocarcinoma of pituitary adrenocorticotropic hormone (ACTH) which is not relieved in the early postoperative period. Methods A retrospective analysis of 266 cases of pituitary ACTH adenoma data, were trans-sphenoid sinus surgery, including postoperative early endocrine did not ease in 44 cases (16.5%). In 44 cases, 34 cases (77.3%) had pituitary ACTH adenoma and 10 (22.7%) had adenocarcinoma of pituitary adenoma. Thirty cases (68.2%) had MRI and 14 cases (31.8%) had MRI negative; 42 cases of adenoma (95.5%), 2 cases of pituitary adenoma (4.5%). Results Tissue taken by the pathological examination: 25 cases of pituitary adenomas (including 3 cases of atypical pituitary adenoma), 6 cases of pituitary hyperplasia, anterior pituitary or posterior lobe in 13 cases. The patients were followed up for 12-36 months. Delayed relief was achieved in 3 cases, radiotherapy in 29 cases (25 cases of general radiotherapy, Gamma Knife in 4 cases). No treatment was followed up in 2 cases. Postoperative death occurred in 5 cases and lost in 5 cases. In patients with radiotherapy, blood cortisol returned to normal in 11 patients, and 2 were ineffective with bilateral adrenalectomy. CONCLUSIONS: Pituitary ACTH adenomas that have not been reopened early after transsphenoidal approach have not been relieved after 6 months follow-up and should be treated individually according to their condition.