Houssay综合征21例临床资料分析

发布时间：2018-04-05 17:29

  本文选题：糖尿病　切入点：垂体功能减退　出处：《郑州大学》2017年硕士论文

【摘要】：背景与目的Houssay综合征又称糖尿病合并垂体功能减退症,为Bernardo Alberto Houssay(1887-1971)所发现率先提出,1925年,Houssay发现,在切除胰腺产生糖尿病的小狗,若同时切除垂体可减少或阻止糖尿病的发生;而注射垂体提取物可产生糖尿病或加重糖尿病的严重性。这种发现被称为“Houssay现象”。此后,Houssay在20世纪30年代关注了腺垂体与糖尿病直接的关系[1]。在糖尿病基础上由于各种原因如肿瘤、炎症、缺血等所引起起的腺垂体功能减退称为Houssay综合征。其表现隐匿,经常误诊漏诊,最终可导致严重的后果。因此此病的预防和治疗越来越受到关注。Houssay综合征个案报道较多,临床大量病例分析并不多见,因此对郑州大学第一附属医院近十多年临床上遇到的确诊为Houssay综合征患者进行回顾性分析总结,探讨其发病机制、临床特点、治疗及预后等情况。方法回顾性概括总结郑州大学第一附属医院2005年1月至2016年1月期间本院确诊的21例Houssay综合征的患者的临床资料。入组标准:(1)符合1999年世界卫生组织(WHO)提出的2型糖尿病诊断标准,(2)经常反复出现低血糖,停用胰岛素及减少降糖药物低血糖难以纠正,并且最后确定低血糖原因为垂体功能减退所致者;(3)病史、体征及测定下丘脑-垂体-靶腺轴(甲状腺、肾上腺、性腺)激素水平及功能试验均提示垂体功能减退者;(3)排除原发性甲状腺功能减退、Addison病、自身免疫性多发内分泌腺病综合征(APS)、肝病、腹泻等胃肠道疾病者。结果1.一般数据:21例Houssay综合征患者,9例男性,12例女性,男:女=1:1.33;年龄25-78岁,中位年龄60.05岁,其中20-30岁1例,30-60岁9例,大于60岁10例。病程:初诊3例,5个月-6年12例,6-16年6例。垂体瘤2例,希恩综合征4例,颅咽管瘤1例,特发14例;2.临床表现:21例患者均易反复出现低血糖症状;2例入院时有肾上腺危象,脱水伴有低血压,虚脱无力,恶心呕吐,呈嗜睡状态;6例患者出现贫血;18例入院时有低钠血症。4例伴只伴有甲减者怕冷少汗,毛发稀疏,皮肤干燥,记忆力减退等;7例只伴有肾上腺功能减退者疲乏无力、易感染;2例甲状腺功能减退合并肾上腺皮质功能减退者;余8例全垂体功能减退患者;其中入院时2例被误诊为APS,1例被误诊为肿瘤;3.实验室检查:(1)21例患者均发生过低血糖,当时急查血糖2.15±0.82mmol/l;(2)入院时:高血钾2例,低血钾1例,余处于正常范围,均值4.85±0.36mmol/l;6例贫血,余处于正常范围,血红蛋白:116.71±19.56g/l,;低血钠18例,血钠:131.57±4.75mmol/l;TC:4.52±1.05 mmol/l;TG:1.73±0.67mmol/l;ALT:24.33±7.26 U/L;AST:23.38±8.59U/L;(3)21例中共伴有甲状腺功能低下者14例,伴有肾上腺皮质功能低下者17例,伴有性腺功能低下者8例,FT3:3.30±0.54pmol/l,FT4:5.76±2.61 pmol/l,TSH低于正常范围者14例,TSH:0.90±1.056u IU/ml;ACTH(8:00):6.48±4.410pg/ml,COR(8:00):79.11±50.43ng/ml,UFC低于正常范围者17例,UFC:73.81±43.07nmol/d;FSH11.08±3.29m IU/ml,LH:8.69±1.91m IU/ml;(4)垂体MRI表现:18例垂体显著缩小,垂体变薄;4.统计患者口服激素替代治疗前与治疗7天后空腹胰岛素水平,两样本量资料比较应用配对样本t检验,p0.05为差异有统计学意义;甲状腺功能减退者,通过激素替代治疗后,FT3和TSH治疗前后相比较差异无统计学意义(P0.05),而治疗前后相比较FT4差异均有统计学意义(P0.05);肾上腺功能减退者,通过激素替代治疗后,UFC治疗前后相比较差异有统计学意义(P0.05);COR和ACTH治疗前后相比较差异无统计学意义(P0.05);血红蛋白、肝功能、血脂治疗前后相比较差异无统计学意义(P0.05);血钠、血钾治疗前后相比较差异有统计学意义(P0.05)结论1.糖尿病合并垂体功能减退症临床上并不少见。2.糖尿病合并垂体功能减退症临床上较易误诊漏诊,最终延迟治疗。
[Abstract]:Background and objective Houssay syndrome and pituitary function in diabetic patients with hypothyroidism known as Bernardo Alberto, Houssay (1887-1971) found first proposed in 1925, Houssay found that after resection of the pancreas to produce diabetic dog, if resection of pituitary can reduce or prevent the occurrence of diabetes; while the injection of pituitary extract can cause diabetes or more severe diabetes. This finding is known as the "Houssay phenomenon". Since then, Houssay focuses on [1]. relationship of pituitary gland in diabetes and diabetes directly based on due to various reasons such as tumor, inflammation in 1930s, pituitary gland ischemia caused by the loss is called Houssay syndrome. Its occult symptoms, often misdiagnosed finally, can lead to serious consequences. Therefore, the prevention and treatment of the disease more and more attention to the.Houssay syndrome case report more, a large amount of clinical case Analysis is rare, so to meet nearly more than 10 years of Clinical First Affiliated Hospital of Zhengzhou University on the diagnosis of patients with Houssay syndrome were analyzed retrospectively, to investigate the pathogenesis, clinical characteristics, treatment and prognosis. Methods a retrospective summary of the First Affiliated Hospital of Zhengzhou University from January 2005 to January 2016 during the period of clinical data confirmed in our hospital 21 cases of Houssay syndrome patients. Inclusion criteria: (1) with the 1999 WHO (WHO) proposed the diagnostic criteria of type 2 diabetes mellitus (2), repeated hypoglycemia, discontinuation of insulin and hypoglycemic drugs reduce hypoglycemia, it is difficult to correct, and finally determine the cause of hypoglycemia caused by pituitary dysfunction; (3) the history, signs and determination of the hypothalamus pituitary gonad axis (thyroid, adrenal and gonadal hormone levels) and functional test showed pituitary dysfunction; (3) excluding primary 鐢茬姸鑵哄姛鑳藉噺閫，

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