淋巴细胞性垂体炎五例临床诊疗分析

发布时间：2018-06-26 17:38

本文选题：垂体疾病 + 垂体柄　；参考：《中国全科医学》2017年02期

【摘要】：目的通过分析淋巴细胞性垂体炎(Ly H)患者临床资料探讨其诊治方法,提高对其临床认识和诊治水平。方法选取2015年郑州大学第一附属医院临床诊断为Ly H患者5例,收集临床表现、内分泌及影像学检查结果、治疗、转归等临床资料。结果 5例患者中男3例,女2例;年龄17~41岁;病程7 d~9年。4例患者出现多饮、多尿,2例出现恶心、呕吐,2例出现性欲减退,1例出现闭经,1例出现头晕、头痛。2例患者促肾上腺皮质激素-皮质醇(ACTH-COR)水平正常,3例ACTH-COR水平降低;2例患者泌乳素(PRL)水平升高,2例PRL水平降低,1例PRL水平正常;2例患者促黄体生成素(LH)、卵泡刺激素(FSH)水平正常,3例LH、FSH水平降低;2例患者甲状腺功能减退。垂体磁共振成像(MRI)示5例患者垂体柄增粗,3例垂体弥漫性增大,2例累及视交叉,2例神经垂体高信号消失。4例多饮、多尿患者行禁水加压试验均符合中枢性尿崩症,其中2例患者垂体MRI示神经垂体高信号存在。患者均给予不同剂量和疗程糖皮质激素治疗,甲状腺功能减退者给予左甲状腺素钠片,中枢性尿崩症患者给予醋酸去氨加压素片。患者症状均有不同程度的缓解,但均未恢复至正常,1例出现股骨头坏死。结论 Ly H主要影像学特点为垂体柄增粗,MRI是该疾病诊断和评估治疗效果简单、有效的方法,中枢性尿崩症有助于与垂体瘤鉴别,糖皮质激素治疗对该疾病有效,但应警惕其不良反应。
[Abstract]:Objective to analyze the clinical data of patients with lymphocytic hypophysitis (Ly H) and to improve their clinical understanding and diagnosis and treatment. Methods five patients with Ly H were selected from the first affiliated Hospital of Zhengzhou University in 2015. The clinical manifestations, endocrine and imaging findings, treatment and prognosis were collected. Results among the 5 patients, 3 were male and 2 female; the age was 1741.The course of disease was from 7 days to 9 years, the course of the disease was from 7 days to 9 years in 4 cases with polydrink, 2 cases with polyuria, 2 cases with nausea, 2 cases with vomiting, 1 case with amenorrhea, 1 case with dizziness, 1 case with dysphoria and 1 case with dizziness. Normal ACTH-COR level in 2 patients with headache 2 patients with elevated prolactin (PRL) level in 2 patients with normal PRL level in 2 patients with luteinizing hormone (LH) and follicular prickles in 2 patients with normal PRL levels. Normal hormone (FSH) levels were found in 3 patients with hypothyroidism and 2 patients with hypothyroidism. Pituitary magnetic resonance imaging (MRI) showed that 3 cases of pituitary stalk thickening and 3 cases of pituitary diffuse enlargement 2 cases involving optic chiasma 2 cases of neurohypophysis hyperintense disappearance of polydrink 4 cases of polyuria patients were in accordance with central diabetes insipidus. In 2 cases, pituitary MRI showed high signal intensity of neurohypophysis. Patients were treated with different doses and courses of glucocorticoid. Patients with hypothyroidism were given levathyroxine sodium tablets and patients with central diabetes insipidus were given desaminopressin acetate tablets. The symptoms of all patients were relieved to varying degrees, but none of them recovered to normal and 1 case had necrosis of femoral head. Conclusion MRI with thickening pituitary stalk is a simple and effective method for diagnosis and evaluation of Ly H. Central diabetes insipidus is helpful to differentiate from pituitary adenoma. Glucocorticoid therapy is effective for this disease. However, we should be on guard against its adverse reactions.
【作者单位】：郑州大学第一附属医院内分泌科;郑州大学第一附属医院小儿外科;
【基金】：河南省教育厅科学技术研究重点项目(14A320049)
【分类号】：R584

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