垂体瘤手术发展史.ppt

A Case of Secondary Hypogonadism “Hypogonadism Due to Pituicytoma in an Identical Twin” H. H. Newnham L. M. Rivera-Woll New Engl J Med 359: 2824, 2008 W. Rose Presentation and History 43-year-old man (an identical twin) presents with 2-year history of lethargy, weakness, headaches; several-year history of gradual loss of body hair and declining libido. Left orchidopexy at 6 years of age. Physical Exam Shows features of hypopituitarism and hypogonadism, including central adiposity, nipple pallor, proximal muscle wasting, preservation of scalp hair, loss of body hair, gynecomastia, and right and left testicular volumes of 12 ml and 5 ml, respectively (normal volume, 15). Note contrast in appearance between hypogonadal patient (Panel A, right) and unaffected identical twin (left). Newnham, H.H. L.M. Rivera-Woll (2008), New Engl J Med 359: 2824. Newnham, H.H. L.M. Rivera-Woll (2008), New Engl J Med 359: 2824. Laboratory Tests Testosterone: 1.5 nmol per liter (normal range, 9.9 to 27.8). Follicle-stimulating hormone: 2.8 IU per liter (normal range, 1.5 to 12.4) Luteinizing hormone: 1.5 IU per liter (normal range, 1.7 to 8.6). Serum prolactin, thyroid function (measured by free thyroxine and thyroid-stimulating hormone), cortisol: normal. Insulin-like growth factor 1 level: mildly decreased. Newnham, H.H. L.M. Rivera-Woll (2008), New Engl J Med 359: 2824. Imaging Magnetic resonance imaging of the pituitary showed a lobulated, contrast-enhancing suprasellar mass (16 by 29 mm; seen in the coronal view in Panel B [arrow] and in the sagittal view in Panel C [arrow]). Images of the unaffected twin are shown for comparison. Newnham, H.H. L.M. Rivera-Woll (2008), New Engl J Med 359: 2824. Newnham, H.H. L.M. Rivera-Woll (2008), New Engl J Med 359: 2824. Pituicytoma, MRI Normal, MRI Diagnosis Pituicytoma = pituitary cell tumor, confirmed by pathological analysis of tissue obtained from needle biopsy and subsequent surgery. Treatment Tumor excision by craniotomy.