神经外科课件：Pituitary Adenoma

PituitaryAdenomaPituitaryEmbryologyCraniopharyngioma颅咽管瘤Histology垂体的生理功能垂体瘤的病人主要为腺垂体功能受影响中英名词对照TRH-TSH-CRH-ACTH-GnRH-GHRH-GH-促甲状腺激素释放激素促甲状腺激素促肾上腺皮质激素促肾上腺皮质激素释放激素促性腺激素释放激素生长激素释放激素生长激素OutlineGHRH-GrowthhormoneaxisCRH-ACTH-cortisolaxisTRH-TSH-thyroxineaxisPart1.生长激素生长激素Growthhormoneisamajoranabolicgrowth-promotinghornone(includingGH,insulin,thyroidhormone,andandrogens)andastresshormone.ActionsofGHasastresshormone:(a)decreseglucoseuptakeintocells(b)increaselipolysisDirectactionsofGHasananabolichormone:IncreaseaminoaciduptakeintocellsMostoftheanabolicactionsofGHareindirectviatheproductionofgrowthfactors.11IGF-1的特性ThemajorknownanaboliceffectofIGF-1isthatitincreasesthesynthesisofcartilageintheepiphysealplatesoflongbones.Itiscirculatingintheplasmatightlyboundtoalargeprotein.Beingboundtoaproteincarrier,itshalf-lifeisverylong(20hours).Becauseithasalonghalf-life,plasmaIGF-1servesasareflectionof24-hourGHsecretion.12生长激素释放的调控GHsecretionispulsatile.SecretionofGHrequiresthepresenseofnormalplasmalevelsofthyroidhormones.Negativefeedback.生长激素在不同年龄阶段的作用Intrauterinegrowth:GHplaysimportantroles.Postnatalandprepubertalgrowth:GHplaysmajorroles,butdependsonthyroidhormones.Puberty:Ifthyroidhormonesarenormal,increasedandrogensdriveGH.Post-puberty:DeficiencyofGHisaproblem.多见于垂体手术之后，应该补充GHPart2.CRH-ACTH-cortisolaxisCRH-ACTH-cortisolaxisCortisol分泌异常，增多？减少？18Addison’sdiseaseCortisollevel严重不足，比如肾上腺全切。FunctionofcortisolStresshormone,promotesthemobilizationofenergystoresProtein:promotesdegradationanddeliveryofaminoacidLipid:increaselipolysisanddeliveryoffreefattyacid

intobloodSugar:raisebloodglucoseCushingdiseaseHypercortisolismCentralobesityPoorwoundhealingHyperglycemiaHyperlipidemiaOsteoporosisThinskin21PermissiveactionsofcortisolCortisolenhancesthecapacityofglucagonandcatecholamines.Glucagon:raisebloodglucoseCatecholamines:vasoconstriction,raisebloodglucosePart3.TRH-TSH-thyroxineaxisTRH-TSH-thyroxineaxisFreeformBoundformFunctionofthyroxineIncreasemetabolismGrowthCHOabsorptionLipolysisBoneturnover,osteoporosisSummary功能改变——内分泌系统症状占位效应——神经系统症状内分泌症状甲亢 Cushing 多毛症/女性化 肢端肥大症 高催乳素血症神经系统症状

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