小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 长期以及进行性症状
- 头痛
- 勃起功能障碍
- 软小睾丸
- 男性乳房发育
- 闭经
- 不育症
- 乳房萎缩
- 性欲下降
- 热潮红
- 发汗
- 体重升高
- 疲劳
- 厌食
- 恶心
- 呕吐
- 虚弱
- 视力下降
- 两颞测偏盲
- 垂体卒中
- 复视
其他诊断因素
- 增加的中央型肥胖
- 肌肉减少
- 便秘
- 怕冷
- 皮肤干燥
- 脱发
- 记忆力障碍
- 情绪低落
- 骨量减少
- 体重减轻
- 烦躁
- 面部麻木
- 平衡失调
- 尿失禁
- 复发性鼻窦炎
- 心动过缓
- 惊厥
危险因素
- 多发性内分泌肿瘤1型（MEN-1）
- 家族性孤立性垂体腺瘤（FIPA）
- Carney综合征（CNC）
诊断性检查
首要检查
- 催乳素
- 胰岛素样生长因子 1
- 黄体生成素、卵泡刺激素
- 人垂体糖蛋白激素的α亚单位
- 睾酮
- 雌二醇
- 促甲状腺激素、游离甲状腺素
- 早晨皮质醇
- 促肾上腺皮质激素 (ACTH) 刺激试验
- 促肾上腺皮质激素
- 对于皮质醇的胰岛素耐量试验
- 基础代谢检查
- 全血细胞计数 (FBC）
- 钆增强的垂体MRI
- 垂体造影增强CT
需考虑的检查
- 生长激素刺激试验
- 血脂
- Humphrey或Goldmann正式视野测试
- 免疫组化染色
治疗流程
垂体卒中
微小腺瘤
没有肿块压迫症状和不毗邻视交叉的巨大腺瘤
无肿块压迫症状但毗邻视交叉的巨大腺瘤
有肿块压迫症状的巨大腺瘤
撰稿人
作者
Gabriel Zada, MD, MS
Assistant Professor of Neurosurgery
Otolaryngology and Internal Medicine
Co-Director, USC Pituitary Center
Co-Director, USC Radiosurgery Center
Director, USC Endoscopic Skull Base Surgery Program
Keck Medicine of USC
University of Southern California
Los Angeles
CA
利益声明
GZ declares that he has no competing interests.
John Carmichael, MD
Associate Professor of Clinical Medicine
Co-director, USC Pituitary Center
Keck Medicine at USC
University of Southern California
Los Angeles
CA
利益声明
JC holds an unpaid position on the editorial board of Pituitary. JC is also a Principal Investigator in the research he undertakes and which is funded by: Novo Nordisk, Chiasma, Novartis, Strongbridge, Milendo, Pfizer, and Crinetics.
鸣谢
Dr Gabriel Zada and Dr John Carmichael would like to gratefully acknowledge Dr Israel Orija and Dr Amir H. Hamrahian, previous contributors to this topic. IO and AH declare that they have no competing interests.
同行评议者
Andrew James, BSc, MB BCh, MD, MRCP, FRCP
Consultant Endocrinologist
Newcastle Hospitals NHS Foundation Trust
Royal Victoria Infirmary
Newcastle
UK
利益声明
AJ declares that he has no competing interests.
Federico Roncaroli, MD
Reader in Neuropathology and Honorary Consultant in Neuropathology
Neuropathology Unit
Department of Clinical Neuroscience
Division of Neuroscience and Mental Health
Faculty of Medicine
Imperial College
London
UK
利益声明
FR declares that he has no competing interests.
Roberto Salvatori, MD
Associate Professor of Medicine
Division of Endocrinology
Johns Hopkins University
Baltimore
MD
利益声明
RS declares that he has no competing interests.
Laurence Kennedy, MD, FRCP
Professor and Chief
Chairman
Department of Endocrinology, Diabetes and Metabolism
Cleveland Clinic
Cleveland
OH
利益声明
LK declares that he has no competing interests.
Shereen Ezzat, MD
Professor of Medicine and Oncology
University of Toronto
Toronto
Ontario
Canada
利益声明
SE declares that he has no competing interests.
Laurence Katznelson, MD
Associate Professor
Stanford University
Palo Alto
CA
利益声明
LK declares that he has no competing interests.
鉴别诊断
- 分泌催乳素的腺瘤（催乳素瘤）
- 生长激素分泌腺瘤（肢端肥大症）
- 促肾上腺皮质激素分泌腺瘤（库欣综合征）
更多 鉴别诊断指南
- 疑似癌症：识别和转诊
- 垂体功能减退成人的 激素替代治疗：美国内分泌学会临床实践指南
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