Hypopituitarism after Surgical Adenomectomy in Adult Patients with Acromegaly-A Review with Emphasis on Growth Hormone Deficiency

肢端肥大症術後之腦下垂體荷爾蒙缺乏–著重論述生長激素缺乏之文獻回顧

宋育民(Yuh-Min Song)

《內科學誌》 29卷4期 (2018/08) Pp. 230-239

https://doi.org/10.6314/JIMT.201808_29(4).04

摘要

Excessive secretion of growth hormone (GH) from a pituitary adenoma and the consequent increase in synthesis and secretion of insulin-like-growth factor-1 (IGF-1) from the liver causes acromegaly. Aggressive treatment is usually required for this disorder, especially for large tumors, with aims to remove the mass lesions as much as possible and correct hormonal abnormalities. In addition to the better known hypopituitarism affecting the pituitary-adrenal, -thyroid, and/or -gonadal axes, a rare but clinically significant outcome of treatment is a deficiency of GH. In the long run, this may result in a decrease in lean muscle mass, fat accumulation, and increases in the incidence of metabolic syndrome and diabetes, thereby increasing morbidity and mortality in this patient population. Poor quality of life is another dominant feature of a lack of GH. Although there is still controversy about the long term benefits for health maintenance and mortality after GH replacement, a close look into the potential benefits of replacement therapy in correction of the multiple abnormalities caused by GH and IGF-1 deficiencies is still warranted. This literature review was undertaken to raise clinical attention and concern about the recognition, diagnosis, and treatment of various forms of hypopituitarism after surgery on the pituitary gland, with emphasis on GH deficiency.

關鍵字

Acromegaly ； Adult ； Growth hormone deficiency ； rhGH replacement

並列摘要

因腦下垂體腺瘤過度分泌生長激素引起之肢端肥大症，絕大部分之病患需要以手術方式摘除腺瘤，但往往仍需輔以各類其他療法，才能將生長激素及類胰島素生長因子-1盡量控制在正常範圍，以緩解臨床症狀。然而，除了較被熟知的中樞型腎上腺低下症、甲狀腺低下症，及性腺低下症，有少數病患在術後產生生長激素缺乏的狀況，諸多心血管疾病之風險因子因而產生，如脂肪堆積，骨骼肌減少，代謝症候群，糖尿病，骨密度下降。統計顯示，這些疾患都增加了病患的患病率及死亡率；另外，在前瞻性的臨床實驗中，已證實生長激素製劑的補充療法，已可有意義的緩解前述病症之嚴重程度，此少見疾病之診斷及療法因此值得做一探討。