間脳下垂体疾患の経時的内分泌機能変化と予後

ENDOCRINOLOGICAL EVALUATION OF PITUITARY FUNCTION IN THE PROGNOSIS OF HYPOTHALAMO-PITUITARY DISORDERS

I．はじめに

　近年，各種下垂体ホルモン血中濃度のradioimmuno—assayによる定量法の確立と，視床下部releasing hor—moneの合成の成功は，内分泌学に関する知見を爆発的に増加させた。これとともに，脳神経外科領域においても，下垂体前葉機能検査が，日常臨床検査としておこなわれる様になつた。従来より内分泌異常を呈する代表的な脳神経外科疾患とされてきたトルコ鞍周辺部腫瘍や，松果体部腫瘍などに関する内分泌学的研究は，わが国では，景山^13）川淵^49）魚住^52）らによつて多数報告されている^25,37,51）。しかしながら，腫瘍以外の間脳下垂体障害についての報告は少ない。また実際の臨床経過あるいは，機能予後との関係を述べた報告も少ない。

　我々はこの点に注目し，頭蓋内腫瘍のほか，脳動脈瘤，頭部外傷などについての下垂体前葉機能の変化を，臨床内分泌学的に研究し，疾患別に報告してきた^41〜44）。今回はこれらをまとめて，原因疾患のことなる種々の間脳下垂体障害の臨床内分泌機能経過に関する諸因子の分析を行なつた。

Chronological endocrine changes accompanying various diseases in the hypothalamo-pituitary region (183 cases) were collectively studied by evaluating both endocrinological symptoms and anterior pituitary functions, with the following results:

1) Endocrine disorders following the operation, trauma and subarachnoideal hemorrhage in thepituitary-diencephalic region varied in the order of a) subclinical, b) clinical and c) paradoxical. This trend was especially marked in young cases of pituitary adenoma and of craniopharyngioma.

2) In young patients, the secretion of anterior pituitary hormones was markedly improved, particularly, TSH showed hypersecretion. The clinical symptom, however, remained unimproved.

3) The alteration associated with the adhesion of pituitary-diencephalic region was significant for the endocrine disorder. Such alteration was observed at 2-6 months after traumatic subarachnoideal hemorrhage.

4) The endocrine disorder developed and exac-erbated in 6 months to 2 years after radio therapy of the pituitary-diencephalic region.

5) For the extimation of recurrence of tumors in the pituitary-diencephalic region endocrinological assessment was very useful.