뇌하수체선종 환자에서 감마나이프를 이용한 정위적 방사선 치료

차봉수(Bong Soo Cha),이현철(Hyun Chul Lee),최동훈(Dong Hoon Choi),송영득(Young Duk Song),이은직(Eun Jig Lee),임승길(Sung Kil Lim),박용구(Yong Gu Park),김경래(Kyung Rai Kim),정상섭(Sang Seop Chung),허갑범(Kap Bum Huh),정윤석(Yoon Sok 대한내과학회 1995 대한내과학회지 Vol.49 No.1

N/A Objectives : Stereotactic radiosurgery using gamma-knife in adjunct to transsphenoidal pituitary surgery is recently being used for treatment of pituitary adenomas and it poses as an effective and safe treatment modality. We present our experience and preliminary results of gamma-knife treatment of the patients with pituitary adenomas. Methods: Between May, 1992 and March, 1994, 20 patients with pituitary adenoma were treated with gamma-knife at Yonsei Medical Center. Among them, 15 cases who have had follow-up for more than 6 months were included in our study. 13 of 15 cases had endocrinologically active tumors(4 prolactin secreting, 4GH secreting, 5 ACTH secreting), and two patients had clinically non-functioning adenomas. Hormonal and radiological studies and clinical features were followed up. Results: After gamma-knife surgery, the hormonal level was decreased in eleven of thirteen patients with functioning pituitary adenomas and the size of tumor was decreased in seven of fifteen patients and eleven of fifteen patients were improved clinically. There was more favorable results in Cushing's disease than in other pituitary adenomas. There was no severe complication associated with gamma-knife surgery, Conclusion : Based on our initial clinical experience, we believe that gamma-knife stereotactic radio surgery is safe and effective alternative to conventional neurosurgery in selected patients with pituitary adenomas and further study might be warranted.

종괴의 완전한 수술적제거를 시행한 뇌하수체 종양 환자의 10 년간의 추적 연구 : 2, 5 년간의 결과 분석 Preliminary Report - 2, 5 Years Follow Up

김동익,허갑범,임승길,이은직,이병희,이규창,김선호,윤주헌,최수연,최중언,정상섭 대한내분비학회 1995 Endocrinology and metabolism Vol.10 No.2

The goal of the pituitary tumor surgery is restoration of the normal endocrine function and releaving the pressure effects of the tumor mass on the adjacent neural structures. The authors had proceeded with the 10 years prospective follow-up study for the endocrine function and recurrence of pituitary tumor in the patients who received the complete total resection of tumor mass by the means of total capsulectomy. The authors will discuss the preliminary result of 2.5 years follow-up of this study(J Kor Soc Endocrinol 10: 85-94, 1995).

쿠싱병의 임상적 고찰

김태승,이경미,이찬희,김영수,김동익,허갑범,이현철,이은직,김경래,조재식,이규창,정상섭,윤도흠 대한내분비학회 1993 Endocrinology and metabolism Vol.8 No.3

Cushing's syndrome caused by ACTH secreting pituitary adenoma or by corticotroph hyperplasia in referred to Cushing's disease. Since the original description of Cushing's disease by Harvey Cushing in 1932, lthere has been marked progression in the etiology, diagnosis and treatment of this disorder. Despite the progression, the diverse clinical, endocrinological and pathological features of Cushing's disease remin incompetely understood and there also remain many problems to be resolved about the diagnosis, treatment, and prognosis of Cushing's disease. Sixteen cases with Cushing's disease were evaluated in this study. The follwing results were obtained. 1) The patients consist of 12 females and 4 males and the age was ranged from 18 to 47 years. 2) Among 16 patients, 14 patients showed central obesity and buffalo hunp, 13 moon face. Among 12 female patients, 10 patients showed abnormalities of menstration. 3) Elevated levels and loss of diurnal variation of the serum cortisol were observed in all patients, and increased 24hr urine free cortisol in 11 out of 12 patients tested. Urinary cortisol excretion was not suppressed by low dose dexamethasone suppression test but suppressed by high dose dexamethasone test. 4) Computed tomogram and MRI revealed that 15 casese were micreadenoma and 1 was macroadenoma. 5) The modalties of treatment were TSA (11 cases), TSA with Radiotherapy (2 cases), and r-knife radiosurgery (3 cases). 6) During the follow up periods(2~31 months), 2 cases were recurred. In conclusion, 15 cases of 16 Cushing's disease were microadenoma. The standard dexamethasone suppression test was useful in the biochemical diagnosis, and inferior petrous venous sampling was also needed to clarify the localization of tumor which was not detected by MRI or CT scan.( J Kor Soc Endocrinol 8: 273~280, 1993).

성장호르몬과 프로락틴분비 뇌하수체선종의 In Situ Hybridization에 의한 분석

김태승,정현주,허갑범,이현철,임승길,이은직,김경래,남문석,이규창,김선호,조재화,최중언,정상섭 대한내분비학회 1994 Endocrinology and metabolism Vol.9 No.2

A non-isotopic in situ hybridization method with biotin-labelled oligonucleotide probes was used to examine growth hormone(GH) and prolactin(PRL) gene expression in 32 patients with pituitary adenomas; 13 were prolactinomas, 8 GH secreting adenomas, and 11 mixed GH and PRL secreting adenomas. Positive immunostaining for GH was found in all patients with GH secreting adenomas, and mixed GH and PRL secreting adenomas. Positive immunostaining for PRL was found in all patients with prolactinomas and 9(81.8%) of 11 mixed GH and PRL secreting adenomas, 5(62.5%) of 8 GH secreting adenomas. Immunohistochemistry revealed that 13 were lactotrope adenomas, 5 somatotrope adenomas, and 14 GH and PRL cell adenomas. In situ hybridization revealed that GH mRNA expression was found in all the patients with somatotrope adenomas and GH and PRL cell adenomas, and 6(46.1%) of 13 lactotrope adenomas. PRL mRNA expression was 100% in lactotrope and GH and PRL cell adenomas, and 4(80.0%) of 5 somatotrope adenomas. The patients with a clinical diagnosis of acromegaly had detectable PRL mRNA in their neoplasm and it is suggested that the PRL cells in the adenomas did not result from dedifferentiation, but from the neoplastic stimulus for some mixed tumors probably occurred in cells previously committed to produce PRL and GH. In lactotrope adenomas, the PRL cells of the patients without expression of GH mRNA may be arised from cells programmed to secrete PRL or precussor PRL cells rather than from mixed GH-PRL cells. The finding that some patients produced mRNA detectable by in situ hybridization, but no hormone detectable by immunohistochemistry within tumor was suggested of a silent adenoma. These observations indicated that in situ hybridization studies may improve the classification of pituitary adenomas and may provide a precise knowledge of the biology of these neoplasms.(J Kor Soc Endocrinol 9:82-92, 1994)

임상적 비기능성 뇌하수체선종의 내분비학적 및 형태학적 특징

김태승,정현주,허갑범,이현철,임승길,이은직,김경래,송영득,남문석,이규창,조재화,최중언,정상섭,김선호 대한내분비학회 1994 Endocrinology and metabolism Vol.9 No.3

Forth-nine patients with clinically nonfunctioning pituitary adenomas were evaluated clinically, endocrinologically and morphologically in this study. The results obtained were as follows. 1) The mean age was 47.1 years(range 23 to 76 years), and 22 were male(44.9%) and 27(55.1%) female. 2) The major clinical manifestations of male patients were visual disturbance(72.7%), headache(54.5%), loss of libido(45.5%), but those of female visual disturbance(59.6%), headache(48.1%), amenorrhea(48.1%), loss of body hair(25.9%), and galactorrhea(22.2%). 3) All were macroadenomas evaluated by CT scan, and in the male patients 16(72.7%) were grade Ⅲ and 6(27.3%) grade Ⅳ by Hardy classification, and in the female patients 6(22.2%) were grade Ⅱ, 12(44.4%) grade Ⅲ, and 9(33.3%) grade Ⅳ. 4) The elevation of serum prolactin were observed 7(31.8%) out of male, and 24(88.9%) of female. 5) Combined stimulation test revealed that GH insufficiency was 89.6%, ACTH 58.9%, LH 58.7%, FSH 51.1 %, and TSH 50.0% and hormone insufficiency more than 4 pituitary hormone was 54.2%. 6) Prolactin response to TRH decreased in 12(70.6%) of 17 patients with normal basal prolactin, and 19(76.0%) of 25 with elevated prolactin. 7) Immunohistochemistry revealed that null cell adenoma was 57.1%, gonadotrope adenoma 26.5%, plurihormonal adenoma 8.0%, silent corticotrope adenoma 4.0%, thyrotrope adenoma(2.0%), and lactotrope adenoma(2.0%). 8) The ultrastructural characteristics examined by electron-microscopy were similar despite of immunohistochemical differences. In summary, the prevalance of clinically nonfunctioning pituitary adenoma was middle aged men and women, and their main symptoms were visual disturbance and headache. Hyperprolactinemia and pituitary hormone insufficiency more than 4 hormone were observed commonly. Most of them were null cell adenoma and gonadotrope adenoma examined by immunohistochemistry. Further study using modern techniques: cell culture, subunit-immunostaining. And Northern blot analysis of mRNA for pituitary hormone or subunit, will be needed to clarify null cell adenomas(J Kor Soc Endocrinol 9: 220-212, 1994).