脳動脈瘤症例における視床下部下垂体機能の検討 : 特に成長ホルモン分泌について

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The present study was performed to evaluate the hypothalamo-pituitary function in cases with cerebral aneurysm. 1. To assess the hypothalamo-pituitary function, serum human growth hormone (HGH) levels were measured after insulin-induced hypoglycemia, befor and after the surgery. 2. Impairment of HGH secretion was observed in 69 cases out of 142 cases (41%) before the operation and 47 cases out of 96 cases (49%) after the operation. 3. A high frequency of impaired HGH level was found in the cases which were measure in the acute phase within 4 weeks after the subarachnoid hemorrhage (22 cases out of 34 cases: 65%) and 2 weeks after the surgery (28 cases out of 48 cases: 58%), which had shown prolonged disturbance of consciousness after the subarachnoid hemorrhage (26 cases out of 43 cases: 60%) and continued to show the various neurological deficits (30 cases out of 55 cases: 55%). 4. The aneurysms at the internal carotid artery, followed by those at the anterior communicating artery (13 cases out of 50 cases: 26% and 11 cases out of 63 cases: 17%, respectively), were most likely to produced the severe impairment of HGH levels. On the contrary, the impairment was rare in the middle cerebral aneurysms (2 cases out of 24 cases: 8%). 5. The moderate to severe impairments were seen in 3 cases out of 4 cases with the giant aneurysm in the internal carotid artery and all 4 cases showed severe internal hydrocephalus. 6. The newly appeared impairment after the surgery was not seen when the microsurgical techniques were used in the operation. 7. In case of anterior communicating aneurysms, the projection of the aneurysmal dome influenced on the HGH levels after the surgery; the upward projection impaired the function more frequently than the downward projectnon. 8. We think that impaired HGH levels were caused by several factors as follows; the circulatory disturbance and brain damage in the hypothalamo-pituitary region after the subarachnoid hemorrhage, surgical maneuver and direct compression by the giant aneurysm on the same region, and presumably the corticosteroid administration in acute phase after the surgery.
日本脳神経外科学会の論文

脳動脈瘤症例における視床下部下垂体機能の検討 : 特に成長ホルモン分泌について

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