原发性空蝶鞍123例临床分析  

A clinical analysis of 123 cases of primary empty sella

作　　者：李娟[1] 贾红蔚[1] 王昌兰 张然[2] 瞿明月 李威[3] 袁梦华[1] 崔瑾[1] 何庆[1] 卫红艳[1] 朱铁虹[1] 马中书[1] 刘维[1] 董作亮[4] 高志红[1] 

机构地区：[1]天津医科大学总医院内分泌代谢科,300052 [2]天津医科大学总医院病案统计科,300052 [3]天津医科大学总医院医学影像科,300052 [4]天津医科大学总医院特检中心,300052

出　　处：《中华内科杂志》2017年第4期268-272,共5页Chinese Journal of Internal Medicine

摘　　要：目的分析原发性空蝶鞍的临床特点及垂体功能变化情况。方法对2010年1月至2016年5月收治的123例原发性空蝶鞍患者的临床资料进行回顾性分析。结果（1）入组的123例患者中，女80例，男43例；年龄（59．2±13．6）岁，以50～69岁女性多见。（2）主要表现为乏力69例（56．1％）、头晕头痛42例（34．1％）、恶心呕吐22例（17．9％）、性腺功能紊乱21例（17．1％）、视力障碍7例（5．7％）、垂体危象4例（3．3％）。（3）66例（53．7％）患者出现不同程度腺垂体功能减退，其中，肾上腺轴、性腺轴和甲状腺轴功能减退发生率分别为36．6％、31．7％、17．1％；完全性空蝶鞍较部分性空蝶鞍更易出现腺垂体功能减退（P〈0．05）。（4）16例（13．0％）患者合并其他自身免疫病（11例为Graves病），另有2例为库欣综合征（肾上腺腺瘤）合并原发性空蝶鞍。结论腺垂体功能减退症在原发性空蝶鞍中并不少见，以肾上腺皮质轴功能损害最多见，因此，凡有头痛和／或乏力及怀疑原发性空蝶鞍者，均需全面评估垂体功能，及时替代治疗并需长期随访。Objective This study was conducted to analyze the clinical characteristics and pituitary function of patients with primary empty sella （PES）. Methods The clinical data from 123 hospitalized adult patients with PES from January 2010 to May 2016 were retrospectively studied. Results （ 1 ） The average age of the 123 （ male 43, female 80 ） PES patients was （ 59.2 ± 13.6 ） years （ ranging 24 - 92 years）, among whom 61% patients were in the age group between 50 -69 years. （2） The symptoms of the patients included fatigue （56. 1% ）, headache （34. 1% ）, nausea and vomiting （ 17.9% ）, gonadal dysfunction （ 17. 1% ）, visual disturbance （ 5.7% ） and hypopituitarism crisis （ 3.3% ）. （ 3 ） Hypopituitarism was found in 66 of the 123 patients. Among them, 36. 6% , 31.7% and 17. 1% were central hypoadrenalism, hypogonadism, and hypothyroidism, respectively. The percentage of hypopituitarism in complete PES was significantly higher than that in partial PES （ P 〈 0. 05 ）. （4） Sixteen patients were concomitant with other autoimmune diseases including ll patients with Graves＇ disease and 2 with Cushing＇s syndrome due to adrenal adenoma. Conclusions The incidence of hypopituitarism in PES was 53.7%, in which the pituitary-adrenal axis bypofunction was more common. An overall evaluation of the pituitary function was essential for the patients who had headache and fatigue, or with suspected PES. The patients with hypopituitarism should be given hormone replacement therapy in time and followed up afterword.

关 键 词：空蝶鞍 垂体功能减退症 乏力 

分 类 号：R741[医药卫生—神经病学与精神病学]