摘要：

研究背景 头痛是垂体生长激素腺瘤的常见症状，多于肿瘤切除后缓解，但仍有少数患者出现持续性剧烈头痛，临床较少见且治疗困难。本文总结垂体生长激素腺瘤相关顽固性头痛的临床特点及诊治经验。方法与结果 纳入2014年2月至2017年7月4例垂体生长激素腺瘤相关顽固性头痛患者，均再次行经蝶窦入路垂体腺瘤切除术以及长效生长抑素类似物缓解头痛。术前血清生长激素（GH）、胰岛素样生长因子-1（IGF-1）和口服葡萄糖耐量（OGTT）试验GH谷值分别为（5.80±2.86）、（644±249）和（3.12±1.37）μg/L，数字评价量表（NRS）评分（7.50±0.58）分；术后7天内复查GH、IGF-1和OGTT试验GH谷值为（3.50±2.91）、（362.25±160.11）和（3.28±2.99）μg/L，NRS评分（1.75±0.50）分；术后3个月复查GH、IGF-1和OGTT试验GH谷值为（3.10±2.14）、（357±165）和（1.54±1.24）μg/L，NRS评分为（3.75±1.50）分。结论 长效生长抑素类似物可用于治疗垂体生长激素腺瘤相关顽固性头痛，可有效缓解头痛症状。

关键词: 垂体肿瘤, 分泌生长激素的脑垂体腺瘤, 肢端肥大症, 头痛, 生长抑素

Abstract:

Background Headache is a common complaint in growth hormone (GH)-secreting pituitary adenoma and considered to be relieved after tumor removed. However, some headache could be resistant after surgery, which is rare and intractable. This article summarized the clinical characteristics and diagnosis and treatment of intractable headache combined with GH-secreting pituitary adenoma. Methods and Results Four intractable headache combined with GH-secreting pituitary adenoma patients hospitalized in Peking Union Medical College Hospital from Febuary 2014 to July 2017 were reviewed. All the 4 patients received transsphenoidal surgery again and took long-acting somatostatin analogs (SSTAs) to control headache symptoms after admission. The serum GH, insulin-like growth factor-1 (IGF-1) and GH in Oral Glucose Tolerance Test (OGTT) before surgery were (5.80 ±2.86), (644 ±249) and (3.12 ±1.37) μg/L, (3.50 ±2.91), (362.25 ±160.11) and (3.28 ±2.99) μg/L in 7 days after surgery, and (3.10 ±2.14), (357 ±165) and (1.54 ±1.24) μg/L 3 months after surgery. Numeric Rating Scale (NRS) was (7.50 ±0.58), (1.75 ±0.50) and (3.75 ±1.50) score in different timepoints. Conclusions Long-acting SSTAs can be effective to intractable headache combined with GH-secreting pituitary adenoma, further studies are needed.

Key words: Pituitary neoplasms, Growth hormone-secreting pituitary adenoma, Acromegaly, Headache, Somatostatin