下垂体prolactinomaの治療と視機能について

Treatment of pituitary prolactinoma and visual function

　12歳の男性．頭痛，複視を訴えて来院．視力右眼1.5，左眼0.8（nc），両耳側半盲を呈していた．血清プロラクチンは高値（2,300ng／ml）を示し，computed tomography （CT）にてトルコ鞍内に腫瘍陰影が認められた．プロモクリプチンの投与で視力，視野の改善，腫瘍の縮小を認めたが，1年半経過した現在，左眼に軽度の耳側半盲を残している．早期発見と早期治療のためには症状，視機能検査のみならず，内分泌検査，放射線検査などを行うことが重要である．

　少年の高プロラクチン血症は比較的稀であるが，本症例ではプロモクリプチンが高プロラクチン血症と視機能障害を著しく改善した．

A 12-year-old male child noticed diplopia since one year before. He sought medical advice for headache and impaired vision in his left eye. We detected bitemporal hemianopia and elevated plasma prolactin level of 2,300 ng/ml. Computed tomography showed the presence of a tumor mass within the sella turcica extending to the suprasellar area. We diagnosed the patient as prolactinoma andinitiated oral bromocriptine treatment at the doses of 2.5 to 5 mg per day.

Within one week after start of therapy, visual acuity recovered to normal. One month after start of bromocriptine, visual field remarkably improved with marked decrease in plasma prolactin level. We also confirmed marked reduction in tumor size on CT scans. Improvement in clinical symptoms thus lasted till 15 months later.

Rinsho Ganka (Jpn J Clin Ophthalmol) 41(8) : 987-991, 1987