Hypothalamo-pituitary surveillance imaging in hypopituitary patients receiving long-term GH replacement therapy
Hypothalamo-pituitary surveillance imaging in hypopituitary patients receiving long-term GH replacement therapy
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DOI：
10.1210/jc.86.11.5172
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发表时间：
2001-11-01
影响因子：
5.8
通讯作者：
Monson, JP
中科院分区：
文献类型：
--
作者：
Frajese, G;Drake, WM;Monson, JP
大多数成人型（AO）GH缺乏症（GHD）的病例是由下丘脑-垂体瘤或其治疗引起的。生长激素替代疗法现在被广泛用于垂体功能减退症的成人，但其对下丘脑-垂体肿瘤生长或复发的影响尚不清楚。来自成人GH替代治疗早期经验的轶事证据记录了偶尔的肿瘤复发，但这与GH使用的任何关系尚不清楚。我们现在已经前瞻性地成像的垂体腺的100例连续患者（60名女性，40名男性;平均年龄，46岁;范围，18-69岁）谁有AO-GHD后，适当的治疗垂体或垂体周肿瘤。对91例患者进行了体外放射治疗。所有患者均接受剂量滴定方案治疗，以将血清IGF-I维持在年龄相关参考范围的中位数和上限之间。所有患者在开始GH治疗前和治疗6个月和12个月后进行了放射性核素显像，92例患者在2年时再次进行，63例患者在3年时再次进行，23例患者在4年后再次进行。仅1例患者在6个月时有轻微的鞍内组织增大的证据;继续使用GH替代治疗，在6个月至12个月之间没有进一步变化。在所有其他患者中，在GH长期随访期间，外观无变化或组织量减少。我们已经证明，下丘脑-垂体瘤复发是非常罕见的，在这段时间内，这组GH治疗的患者，这是令人放心的。对未接受术后放疗的患者进行类似的前瞻性纵向观察，并与对照系列中的肿瘤复发率进行比较，是可取的。
Most cases of adult-onset (AO) GH deficiency (GHD) result from the presence of hypothalamo-pituitary tumors or their treatment. GH replacement is now widely used in adults with hypopituitarism, but its effect on hypothalamo-pituitary tumor growth or recurrence is unknown. Anecdotal evidence from early experience of GH replacement in adults documented occasional tumor recurrence, but any relationship of this to the use of GH was unclear. We have now prospectively imaged the pituitary glands of 100 consecutive patients (60 females, 40 males; mean age, 46 yr; range, 18-69 yr) who had AO-GHD after appropriate treatment for a pituitary or peripituitary tumor. External radiotherapy had been given to 91 patients. All patients were treated with a dose titration regimen to maintain serum IGF-I between the median and upper end of the age-related reference range. Pituitary imaging was performed before the commencement of GH and after 6 and 12 months of treatment in all patients, again at 2 yr in 92 patients, at 3 yr in 63 patients, and after 4 yr in 23 patients. In only one patient was there evidence of slight intrasellar tissue enlargement at 6 months; GH replacement was continued, and there was no further change between 6 and 12 months. In all other patients, either the appearances were unchanged or the amount of tissue was reduced during long-term follow-up on GH. We have shown that hypothalamo-pituitary tumor recurrence was thus very rare over this time period in this group of GH-treated patients, and this is reassuring. Similar prospective longitudinal observation of patients who have not received postoperative irradiation and comparison with rates of tumor recurrence in control series are desirable.