Acromegalyの手術的治療第2部：内分泌学的変化の総括

SURGICAL TREATMENT OF ACROMEGALY Part 2: SUMMARY OF ENDOCRINOLOGICAL FOLLOW UP

　第1部（第25巻・第7号）に述べた，1例の外部照射と，6例の経鼻的手術法を行なつた症例について，術前及び術後の内分泌学的各データーの推移について，とりまとめて記載すると共に，若干の考察を加える。

7 cases of acromegaly or gigantism were treated in Tenri Hospital during past 5 years. Every cases showed pituitary adenoma neuroradiologically.

1) β-tron irradiation in 1 case was ultimately ineffective, which was the similar result to reports in the past.

2) Two adenomas were curetted under the fluoro-scopic control through Hirsch's transseptal trans-sphenoidal route. This procedure alone was not sufficient to reduce the human growth hormon (HGH) to normal level (under 5 mitgldl.). Combi-nation with postoperative irradiation course was necessary for this purpose. 4 tumors were extir-pated by Hardy's oronasal transsphenoidal oper-ation under operative microscope and fluoroscopic control. HGH reduced to normal level in 3 cases and remained slightly above the normal range in 1 case of which tumor was so fibrous and hard.

3) 3 cases out of 7 had diabeted mellitus preo-peratively. 2 of these showed normal GTT-curve and also normal HGH value postoperatively. But in 1 case of which GTT-curve still showed diabetic type, HGH remained slightly higher than normal postoperatively.

4) Adrenocortical and thyroid function were partially hyperactive in 1 case, and normal or slight hypofuntional in other cases. Grade of endocrino-logical hypofunction still progressed postoperatively and steroid compensation therapy was necessary in 1 case.

5) 1 case which suffered from tranient pesto-perative meningitis due to CSF leakage showed diabetes insipidus for about 2 months following surgery. It was conpensated spontaneously.

6) No case showed abnormality in serum elect-rolyte. Serum cholesterol was above normal range in 2 cases before surgery and in 4 cases after surgery.

7) Surgical extirpation of adenoma by Hardy's methcd was considered to be more ideal procedure at the present time than conventional one for treat-ment of hypersecretion of HGH. Effort must be made to minimize the postoperative endocrinological deficit and to normalize constantly the HGH value simultaneously.