肉芽肿性垂体炎的诊断和治疗  

Diagnosis and management of granulomatous hypophysitis

作　　者：楼林[1] 王天华[1] 赵元元[1] 蔡学祥[2] 马杰[3] 卢刚[1] 

机构地区：[1]浙江省人民医院神经外科,杭州,310014 [2]浙江省人民医院影像科,杭州,310014 [3]浙江省人民医院病理科,杭州,310014

出　　处：《中华神经外科杂志》2013年第5期507-511,共5页Chinese Journal of Neurosurgery

摘　　要：目的探讨肉芽肿性垂体炎的影像学特征及其诊断和治疗。方法回顾性分析7例肉芽肿性垂体炎的临床表现、影像学特征、诊断和治疗。结果7例肉芽肿性垂体炎术前误诊6例。临床表现主要为头痛、尿崩症、高泌乳素血症和垂体功能低下。影像学特征主要表现为鞍区病变沿增厚的垂体柄呈“舌状”向鞍上扩展。6例采用经鼻蝶窦入路，1例因术前诊断垂体脓肿而采用经额下入路手术治疗，术后口服激素替补治疗，多数症状缓解，影像学检查证实病灶明显缩小甚至消失。结论肉芽肿性垂体炎手术治疗可明确病理诊断，缓解症状，术后应口服激素替补治疗，定期随访。Objective To investigate the diagnosis and management of granulomatous hypophysitis. Methods Seven patients with granulomatoushypophysitis were retrospectively analyzed with their signs and symptoms, radiological characteristics, diagnosis, and treatments. Results In the seven cases, six cases were misdiagnosed before operations. The clinical signs were headaches, diabetes inspidus, hyperprolactinemia, and hypopituitarism. Pituitary stalk thickening is a prominent image feature and is associated with the tongue - like extension of the sellar lesion into the suprasellar region. Surgery via the transsphenoidal route was performed on six cases and the transfrontal approach was chosen for one patient due to the additional diagnosis of onabscess preoperatively. Most of the patients had remission of clinical symptoms and signs after surgery with steroids and hormones replacement and lesions were reduced or even disappeared on MRI images. Conclusions Surgical intervention should be performed because it is difficult to make correct pathological diagnosis of granulomatous hypophysitis preoperatively and may improve symptoms and signs. Steroids and hormones replacement should be administrated after surgery and patients should be followed - up because of the natural course of the disorder.

关 键 词：肉芽肿性垂体炎 尿崩症 高泌乳素血症 垂体功能低下 治疗 

分 类 号：R736.4[医药卫生—肿瘤]