特集 脳神経画像Critical Findings-おさえておきたい症状とCT/MRI画像所見 ⅡおさえておきたいCT/MRI所見からの鑑別 下垂体の腫大
特集 脳神経画像Critical Findings-おさえておきたい症状とCT/MRI画像所見 ⅡおさえておきたいCT/MRI所見からの鑑別 下垂体の腫大
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特辑：神经影像学的重要发现 - 应注意的症状和 CT/MRI 表现 Ⅱ 与 CT/MRI 表现应注意的鉴别 垂体肿大
DOI：
10.11477/mf.1436204392
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发表时间：
2021
期刊：
影响因子：
--
通讯作者：
岡田 正康
中科院分区：
文献类型：
--
作者：
米岡 有一郎;岡田 正康
垂体腺瘤是鞍区肿块最常见的病因，但也有其他肿瘤、感染性、炎症性、发育性和血管性病因需要考虑。妊娠促进了母体垂体，尤其是垂体腺的生理增大。垂体的正常成熟顺序显然涉及一个时期的生理性肥大在青少年。由于儿童患者的大多数偶发瘤与激素分泌过多或垂体功能低下无关，结构进展也不常见，因此假设成人推荐的广泛随访评估可能不需要用于儿童。垂体病变患者应进行完整的病史和体格检查，包括垂体功能低下和激素分泌过多综合征的证据评估。有上述任何一种情况证据的患者应接受适当指导的生化评估。所有在磁共振成像上表现为垂体病变毗邻视神经或交叉的患者都应进行正式的视野检查。垂体疾病的紧急情况可能是由于垂体不能分泌一种或多种垂体激素，或由于下丘脑-垂体病变扩大的肿块效应而引起的神经-眼科症状。内分泌急症的早期诊断和及时治疗是必须的。
Pituitary adenomas are the most common cause of sellar masses although there are a number of other neoplastic, infectious, inflammatory, developmental, and vascular etiologies that should be considered. Pregnancy promotes a physiological increase in the size of the maternal pituitary gland, especially adenohypophysis. The normal maturation sequence of the pituitary gland apparently involves a period of physiological hypertrophy in teenagers. As most incidentalomas in pediatric patients are not associated with hormonal hypersecretion or hypopituitarism, and structural progression is not common, it is hypothesized that the extensive follow-up assessment recommended for adults might not be necessary for children. Patients presenting with a pituitary lesion should undergo a complete history and physical examination that includes evaluations for evidence of hypopituitarism and hormone hypersecretion syndrome. Patients with evidence for either of these conditions should undergo an appropriately directed biochemical evaluation. All patients presenting with a pituitary lesion abutting the optic nerves or chiasm on magnetic resonance imaging should undergo a formal visual field examination. Emergencies in pituitary disease can result from the failure of the pituitary gland to secrete one or more pituitary hormones or from neuro-ophthalmological symptoms due to the mass effect of an expanding hypothalamic-pituitary lesion. Early diagnosis and prompt treatment of endocrine emergencies are mandatory.