淋巴细胞性垂体炎1例报告及文献复习  

Diagnosis and management of lymphocytic hypophysitis( a case report and literature review)

作　　者：张开鹏[1] 刘德财[1] 金澎[1] 丰育功[1] 

机构地区：[1]青岛大学附属医院神经外科,266000

出　　处：《临床神经外科杂志》2017年第3期225-227,共3页Journal of Clinical Neurosurgery

摘　　要：目的探讨淋巴细胞性垂体炎的临床表现和影像学特点及治疗原则;提高对淋巴细胞性垂体炎的诊断和治疗水平。方法回顾性分析1例淋巴细胞性垂体炎患者的临床、影像学表现及诊断和治疗经过;并结合相关文献分析淋巴细胞性垂体炎的诊断与治疗。结果 1例分娩后患者,主要临床症状为视觉障碍、多饮多尿。MRI检查示垂体弥漫性增大、垂体柄增粗,垂体后叶短T1信号消失;增强扫描见大致均匀强化。行经翼点入路鞍区病变切除术,术后病理诊断明确。患者术后视力改善明显,但仍有垂体功能障碍及尿崩症状,继续予以激素替代治疗。结论淋巴细胞性垂体炎术前影像学诊断困难,当出现视力减退和视野缺损、复视及尿崩症等临床表现,影像学检查出现垂体增大、均匀强化、垂体柄增粗,垂体后叶短T1信号消失,应考虑淋巴细胞性垂体炎的可能性。早诊断,及时激素替代治疗,对视力减退明显者行手术治疗及适当的对症治疗是提高治疗效果的关键。Objective To investigate the clinical characteristics,imaging features and therapy of lymphocytic hypophysitis,to improve the diagnosis and treatment of lymphocytic hypophysitis.Methods The clinical manifestations,image features,diagnosis and treatment of the patient with lymphocytic hypophysitis were analyzed retrospectively.The diagnosis and differential diagnosis of lymphocytic hypophysitis in combination with review of literatures were explored.The pituitary lesion was resected by pterional approach, it was diagnosised as lymphocytic hypophsitis after the operation.Althogh her vision improved significantly, still with diabetes insipidus and hypopitutarism.The patient was continued giving hormone raplacement therapy in the postoperation.Results The main symptoms of the middle-aged female patient were headache,visual disturbance,polydipsia and polyuria.The contrast MRI revealed enhancing pituitary lesion and pituitary stalk thickening.Conclusion The preoperative diagnosis of lymphocytic hypophysitis is difficult.The lymphocytic hypophysitis should be suspected in patient with early change in visual field and visual acuity,diabetes insipidus,thicken pituitary stalk.Early diagnosis,hormone replacement therapy,prompt operation and symptomatic therapy are the keys to the treatment for lymphocytic hypophysitis.

关 键 词：淋巴细胞性垂体炎 影像学特点 诊断 治疗 

分 类 号：R739.7[医药卫生—肿瘤]