妊娠中・後期における下垂体腺腫—血中ホルモン値と視野変化

Visual field test is superior to radioimmunoassay of blood hormone level in hormone producing pituitary adenoma during pregnancy

　プロラクチン産生下垂体腫の19症例，20回の妊娠中の視野を1,2カ月ごとに検査し，8／20回（40％）に欠損の新たなる出現または欠損の拡大を認めた．一方，同患者の血中プロラクチン値は最初の2〜10週で急激に上昇した後，平衡に達し，以後変動しにくく，最も大切な妊娠中・後期に下垂体の動態を知る有力な指標となりえないことがわかった．このことから，上記患者の妊娠中の下垂体の動態は，血中ホルモン値の小康をもって安心することなく，視野検査の繰返しによって追求されるべきで，欠損の拡大が急なる時は，麦角アルカロイドbromocriptine投与を行って，後に不可逆的病変を残すことのないよう努力すべきである．

We measured the visual field of 19 female pa-tients with prolactin-producing pituitary adenoma during 20 pregnancies on a monthly or bimonthly basis. Visual field defects appeared or enlarged during the pregnancies in 8 of the 20 series (40%). The plasma prolactin levels, as measured by ra-dioimmunoassay in these patients, increased and reached to a plateau at 2 to 10 weeks of gestation, suggesting that it cannot be a good indicator for adenoma grow during the middle and last trimester of pregnancy. The visual field test is more sen-sitive to adenoma or adenoma-related growth of pituitary organ than plasma prolactin level as determined by radioimmunoassary during the mid-dle and last period of pregnancy.