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Growth hormone is 100 times higher than normal, blood pressure is as high as 190mm/Hg, high blood sugar...
For Xiao Chen (pseudonym), 31, the pituitary tumor caused abnormalities in various indications of his body, and if not removed in time, the indicators would further develop and seriously affect his health.
However, Xiao Chen also rarely combined with a syndrome of abnormal bone fiber hyperplasia, resulting in multiple deformities in the skull. Abnormal endocrine disorders and long-term deformed skulls have brought great difficulties to Xiao Chen's treatment.
The MDT team of pituitary tumor of Xiangya Hospital of Central South University combined the advantages of neurosurgery and endocrinology to successfully remove the pituitary tumor for Xiao Chen and reduce his blood sugar, blood pressure, and hormone production to normal levels.
Pituitary tumors cause growth hormone 100 times more than normal, and rare skull deformities bring difficulties to surgery
Admission examination found that Xiao Chen had a 2×2×2 cm large pituitary tumor in the saddle area, resulting in a growth hormone as high as 214 ng/dL, about 100 times that of normal people.
In addition, because the pituitary tumor is close to the hypothalamus, it also has a significant impact on Xiao Chen's blood sugar and blood pressure.
Hypertension with medium and high pressure up to 190 mm/Hg or more requires high-dose insulin and a variety of antihypertensive drugs combined control.
To make matters worse, Xiao Chen also rarely combined with abnormal bone fiber hyperplasia syndrome.
More than 20 years ago, his frontal and sternum began to protrude, and now he has abnormal bone hyperplasia in many parts of his body, especially head deformities.
Due to the abnormal thickening of the frontal bone, mandible, occipital bone and other parts of the head (the thickest part is up to 8 cm), Xiao Chen's head is huge (the maximum head circumference is 78 cm) and extremely asymmetrical.
The long-term deformity has seriously affected the appearance at the same time, but also caused great pressure on Xiao Chen's psychology.
If such a condition is not treated in time and the "culprit" pituitary tumor is not removed, Xiao Chen's symptoms of high blood sugar, hypertension and high growth hormone may further develop, which will have a huge impact on his life, work and mental health.
However, abnormal disorders of hormones, blood sugar, blood pressure levels, and special skull deformities have made his treatment difficult.
【Patient preoperative and postoperative imaging data】
Adjust the endocrine level to create conditions for surgery, and carefully design minimally invasive surgical approaches
After receiving the diagnosis by the neurosurgery department of the MDT team of pituitary tumor MDT team of Xiangya Hospital of Central South University, Professor Li Zhixiong and Professor Li Zhenyan, and the team of Professor Chen Huiling and Professor Liu Zehao of the Department of Endocrinology, a detailed diagnosis and treatment plan was formulated according to Xiao Chen's situation.
First treated by the endocrinology department, through the precise regulation of insulin and other means, regulate his growth hormone, blood sugar, blood pressure, a week later reached the ideal standard, creating good conditions for surgery.
After being transferred to neurosurgery, Director Liu Zhixiong, Professor Li Zhenyan, Attending Physician Gong Xuan, Zhong Weiming and Zhang Jingwei's team of residents conducted detailed preoperative discussions.
Xiao Chen's tumor is mainly located in the sella, and the skull is generally abnormally thickened, which is not suitable for traditional craniotomy, and is more suitable for minimally invasive surgery through the nasal butterfly approach through neuroendoscopy.
Such surgical protocols have less traumatic, faster postoperative recovery, and less impact on brain parenchyma.
However, the bone at the bottom of the small Chen saddle also has abnormal thickening (up to 2 cm thickest) and poor sphenoid sinus gasification.
How to locate the saddle floor during surgery, how to safely and accurately grind away abnormally thickened bone-exposed tumors, and how to make more rational and full use of microsurgery instruments have brought great challenges to this operation.
In addition, Xiao Chen's special deformities of the jaw, airway and thoracic cage also increase the difficulty of surgical anesthesia intubation.
The neuroendoscopic grinding out the "safety tunnel" for 4 hours and successfully removing the tumor
On January 5, Professor Liu Zhixiong's team performed a neuroendoscopic saddle area mass lesion resection for Xiao Chen.
During the operation, the anesthesiologist solved the problem of intubation of the difficult airway by using fibromycoscopy and visual laryngoscope, and the anesthesia effect during the operation was satisfactory.
Surgeons use intraoperative neural navigation systems to assist in locating the saddle floor and tumor location.
The most critical step is to safely and accurately grind out a "tunnel" on the abnormal bone thickness of about 2 cm through neuroendoscopic micromanual operations to expose the tumor hidden in the saddle area, which is extremely difficult and very demanding for the operation of the surgeon.
After 4 hours of hard work, the "safety tunnel" was finally successfully opened.
After more than 2 hours, the tumor was completely removed, and the pathological results confirmed that Xiao Chen did suffer from growth hormone-type pituitary adenoma.
【Associate Professor Li Zhenyan's surgical team uses neuronavigation and endoscopy to perform minimally invasive surgical treatment for patients】
The MDT team of pituitary tumors escorts them throughout the process, and personalized precision treatment helps them to be reborn
Although the operation was successful, Xiao Chenwei's treatment during the surgical period still needed to break through several major barriers.
Such as difficult airway intubation, extubation timing selection, preoperative blood glucose, blood pressure and hormone levels increased and drug control effect is not good.
The MDT team of pituitary adenoma worked together to actively carry out clinical treatment of interdisciplinary co-management, joint rounds, multi-disciplinary consultation, etc. after surgery, and formulated an individualized and precise treatment plan for Xiao Chen in a timely manner, which greatly improved the treatment efficiency and quality.
After about 10 days of combined treatment after the operation, Xiao Chen's blood glucose control effect was obvious, in the absence of antihypertensive drugs, blood pressure has been close to normal, the internal environment is stable, the level of growth hormone has dropped significantly to 11.3ng/dL, and he was successfully discharged from the hospital on January 15.
It is reported that pituitary tumors are tumors originating from the pituitary gland, with pituitary tumor compression symptoms and abnormal hormone secretion as the main clinical manifestations.
Because the pathogenesis of pituitary tumor is not clear and the clinical manifestations are diverse, its diagnosis and treatment involve multiple departments, and the traditional specialty diagnosis and treatment mode not only consumes a lot of energy from both doctors and patients, but also increases the difficulty and cost of treatment.
Professor Liu Zhixiong said that multidisciplinary team collaboration (MDT), as the leading diagnosis and treatment mode in the international medical field, not only meets the needs of patients to obtain comprehensive diagnosis and treatment, but also effectively improves the cure rate of pituitary tumors and improves the quality of life of patients.
In the process of diagnosis and treatment of this difficult case, through the joint diagnosis and treatment of the MDT team of pituitary diseases in the hospital, not only did the patient's clinical symptoms improve significantly, but also the haze that shrouded the patient's psychology was specially swept away.
It fully reflects that MDT teamwork can effectively improve the efficiency of pituitary tumor diagnosis and treatment, standardize and optimize the diagnosis and treatment process, design a suitable diagnosis and treatment plan from a professional and accurate perspective, and provide better treatment and services for pituitary tumor patients.
(Editing Rainbow.) ）
Hunan Medical Chat Special Author: Wang Lu, Xiangya Hospital, Central South University
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