Acromegaly with ‘Normal’ Serum Growth Hormone Levels
Acromegaly with ‘Normal’ Serum Growth Hormone Levels
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血清生长激素水平“正常”的肢端肥大症
DOI：
10.1055/s-2007-1003342
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发表时间：
1992
期刊：
影响因子：
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通讯作者：
R. Fahlbusch
中科院分区：
文献类型：
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作者：
S. Brockmeier;M. Buchfelder;E. Adams;W. Schott;R. Fahlbusch
在埃尔朗根-纽伦堡大学接受初次神经外科治疗的216例生长激素分泌性垂体腺瘤患者中，观察到8例肢端肥大症，其基础生长激素水平“正常”（小于或等于5 ng/ml）。他们都具有肢端肥大症的典型临床特征，在口服葡萄糖负荷后表现出异常的生长激素分泌，并且生长调节素C水平显着升高。GRH-和TRH/GnRH-测试被发现无助于建立诊断。神经放射学检查显示所有患者均为垂体腺瘤。经蝶显微手术切除肿瘤后，8例患者中有7例在口服葡萄糖耐量试验期间生长激素分泌正常。免疫组织学和组织块培养研究记录生长激素分泌垂体腺瘤在所有情况下。作者得出结论，即使发现重复的“正常”（小于或等于5 ng/ml）血清GH水平也不能排除活动性肢端肥大症，当怀疑肢端肥大症的临床诊断时，动态内分泌检测可能揭示这些病例中GH的异常分泌模式。经蝶显微手术切除垂体腺瘤为这些病例提供了很好的临床和内分泌缓解机会。
Among 216 consecutive patients with growth hormone secreting pituitary adenomas who underwent primary neurosurgical treatment at the University of Erlangen-Nürnberg, 8 cases of acromegaly with 'normal' basal growth hormone levels (less than or equal to 5 ng/ml) were seen. They all had the typical clinical features of acromegaly, exhibited an abnormal growth hormone secretion following an oral glucose load, and had markedly elevated somatomedin C levels. The GRH- and TRH/GnRH-tests were not found helpful in establishing the diagnosis. Neuroradiology could demonstrate a pituitary adenoma in all of the patients. Following transsphenoidal microsurgical resection of the tumours, growth hormone secretion during oral glucose tolerance testing was normalised in 7 of the 8 patients. Immunohistology and explant culture studies documented growth hormone secreting pituitary adenomas in all cases. The authors conclude that even the finding of repetitive 'normal' (less than or equal to 5 ng/ml) serum GH levels does not exclude active acromegaly and when the clinical diagnosis of acromegaly is suspected, dynamic endocrine testing may reveal abnormal secretion patterns of GH in these cases. Transsphenoidal microsurgical resection of a pituitary adenoma offers a good chance of clinical and endocrinological remission in these cases.