症例 腫瘍の局在診断に苦慮した症候性ACTHおよびGH産生性重複下垂体腺腫の1例
症例 腫瘍の局在診断に苦慮した症候性ACTHおよびGH産生性重複下垂体腺腫の1例
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病例：一例有症状的产生 ACTH 和 GH 的重复垂体腺瘤，其中肿瘤的定位很困难。
DOI：
10.11477/mf.1436204171
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发表时间：
2020
期刊：
影响因子：
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通讯作者：
齋藤 清
中科院分区：
文献类型：
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作者：
伊藤裕平;神宮字伸哉;佐藤祐介;佐藤 拓;村上友太;藤井正純;佐久間 潤;岩崎麻里子;工藤明宏;島袋充生;喜古雄一郎;岡田正康;齋藤 清
双功能性垂体腺瘤是罕见的，只有少数情况下，过度的临床症状都促肾上腺皮质激素（ACTH）和生长激素（GH）的报告。我们在此报告一例有症状的ACTH和GH双垂体腺瘤，这是离散位于同一垂体。一名38岁女性，因全身不适、面部和下肢水肿、不明原因的体重增加、面部发红、痤疮和鼻肿大就诊。内分泌检查结果符合肢端肥大症和库欣病的诊断标准。术前磁共振成像显示在鞍右侧有一个15 mm的囊肿样病变，被认为是正常的对比增强垂体所包围。我们假设囊肿样病变是一个腺瘤，并进行内窥镜下经鼻蝶手术。然而，囊肿样病变是实质性肿瘤。此外，我们认为是正常垂体的区域也被发现是腺瘤。两个腺瘤均被完全切除。术后血液分析显示ACTH< 1.0 pg/dL，皮质醇1.8 μg/dL，胰岛素样生长因子-1 60 ng/mL，均低于参考水平。组织病理学检查证实了两个腺瘤共存，生长激素产生腺瘤和促肾上腺皮质激素产生腺瘤。我们的结论是，这些腺瘤是内分泌活跃的垂体腺。因此，诊断为双垂体腺瘤。当治疗一个病人的症状引起的多种垂体前叶激素分泌过多，应考虑的可能性共存的多个垂体腺瘤。
Double functional pituitary adenomas are rare, and only a few cases of excessive clinical symptoms of both adrenocorticotropic hormone (ACTH) and growth hormone (GH) have been reported. We herein report a case of symptomatic ACTH-and GH-producing double pituitary adenomas, which were discretely located within the same pituitary gland. A 38-year-old woman presented with general malaise, facial and lower limb edema, unexplained weight gain, facial redness, acne, and nasal enlargement. Endocrinological findings matched with the diagnostic criteria for both acromegaly and Cushing's disease. Preoperative magnetic resonance imaging showed a 15-mm cyst-like lesion on the right side of the sellae surrounded by what was thought to be the normal contrast-enhancing pituitary gland. We assumed that the cyst-like lesion was an adenoma and performed endoscopic endonasal transsphenoidal surgery. However, the cyst-like lesion was a parenchymal tumor. Furthermore, the region we considered to be a normal pituitary gland was also found to be an adenoma. Both adenomas were completely resected. The postoperative blood analysis showed ACTH< 1.0 pg/dL, cortisol 1.8 μg/dL, and insulin-like growth factor-1 60ng/mL, all of which were below reference levels. The histopathological examination confirmed the coexistence of two adenomas, a GH-producing adenoma and an ACTH-producing adenoma. We concluded that these adenomas were endocrinologically active within the pituitary gland. Thus, a diagnosis of double pituitary adenomas was made. When treating a patient with symptoms caused by hypersecretion of multiple anterior pituitary hormones, the possibility of coexisting multiple pituitary adenomas should be considered.