Neurological Surgery 脳神経外科38巻1号

2010年01月発行

連載 脳神経外科疾患治療のスタンダード

14．下垂体腺腫の治療：最近の話題

著者： 泉本修一¹ 有田憲生¹

所属機関： ¹兵庫医科大学脳神経外科

ページ範囲：P.79 - P.89

Ⅰ．先端巨大症の治癒基準

　先端巨大症の治療成績は，開頭術による摘出，放射線治療が行われていた時代と比較し，経蝶形骨洞手術の導入，普及により飛躍的に向上した．その後さらにoctreotide製剤，特に徐放性製剤の開発により手術で正常化できなかった症例の薬物治療成績は改善している．

　この領域における最近のトピックのひとつは，治癒基準の見直しである．従来，成長ホルモン産生下垂体腺腫に対する手術成績は，治癒判定を術後成長ホルモン基礎値10ng/ml以下^3,28,29)，5ng/ml以下^{2,7,16,31,33,43,46)}などの基準値を用いて報告されてきた（Table 1）．臨床例の経験では，術後5ng/ml以下に成長ホルモン値が低下すると，直ちに発汗が減少，頭痛も消失，短期間のうちに手指や足趾の軟部組織の分厚さの減少などが観察できる．しかし，多数の先端巨大症症例の長期経過を追跡した欧米の内分泌医の解析によると，このような治癒基準に達した先端巨大症患者の長期生存率は一般人口に比較して有意に不良である．統計学的には，術後任意に測定された成長ホルモン値が2.5ng/ml以下に低下していれば長期生存率は一般人口と同等であることが示された^20,50)．

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