垂体增生误诊为垂体瘤的原因分析与诊治(附19例临床报告)  

Analysis of the Causes of Misdiagnosis of Pituitary Hyperplasia as Pituitary Adenoma and Its Diagnosis and Treatment (a report of 19 cases)

作　　者：刘见 张楠[2] 夏成雨 Liu Jian;Zhang Nan;Xia Chengyu(Department of Neurosurgery,Anhui Provincial Hospital of Anhui Medical University,Hefei,Anhui 230001,China;Department of Neurosurgery,The First Affiliated Hospital of USTC,Hefei,Anhui 230001,China)

机构地区：[1]安徽医科大学附属省立医院神经外科,合肥230001 [2]中国科学技术大学附属第一医院神经外科,合肥230001

出　　处：《立体定向和功能性神经外科杂志》2023年第2期95-99,共5页Chinese Journal of Stereotactic and Functional Neurosurgery

摘　　要：目的 探讨原发性甲状腺功能减退症致垂体增生被误诊为垂体瘤的原因与诊治,提高临床医生对此病的认识,避免误诊。方法 回顾性分析于我院就诊的19例误诊为垂体瘤的垂体增生患者,分析其临床表现、内分泌检查、影像学特点及误诊原因。随访其治疗后的临床转归结果。结果 19例患者均行垂体磁共振检查,所有患者在影像学报告中都有“考虑为垂体腺瘤”的描述,>10 mm的有17人,其中13例患者泌乳素升高,3例患者有泌乳症状,2例患者误诊为泌乳素腺瘤;<10 mm的有2人,2例患者泌乳素都升高且伴有泌乳症状,2例患者都被误诊为泌乳素腺瘤;所有患者TSH都升高,所有患者都被误诊为垂体瘤,3例患者曾被建议手术。经替代治疗3~19个月后,所有患者的T3、T4、TSH在治疗后都恢复到正常范围,18例患者的垂体恢复到正常大小。结论 对于大于10 mm的垂体增大不能轻易诊断为垂体瘤,对于小于10 mm有泌乳的垂体异常不能轻易诊断为泌乳素腺瘤,所有育龄期女性垂体瘤的诊断应注意与原发性甲减所致垂体增生鉴别,T3、T4、TSH检查发现TSH明显增高不伴T3、T4增高为特点;长期替代治疗,垂体增生可取得良好的治疗效果。Objective To explore the causes,diagnosis and treatment of misdiagnosis of pituitary hyperplasia caused by primary hypothyroidism as pituitary adenoma,so as to improve clinicians' understanding of the disease and avoid misdiagnosis.Methods Retrospective analysis of 19 cases of pituitary hyperplasia misdiagnosed as pituitary adenoma in our hospital,to analyze the clinical manifestations,endocrine examination,imaging features and misdiagnosis reasons.The clinical outcome after long-term treatment was reported.Results All the 19 patients underwent pituitary magnetic resonance imaging,and all the patients had the description of “pituitary adenoma” in the imaging report.There were 17 patients with >10 mm,of which 13 patients had elevated prolactin,3 patients had lactation symptoms,and 2 patients were misdiagnosed as prolactinoma.There were 2 patients with <10 mm,and prolactin was elevated in both patients with lactation symptoms,and both patients were misdiagnosed as prolactinomas.TSH was elevated in all patients,all patients were misdiagnosed as pituitary adenomas,and 3 patients were recommended for surgery.After 3-19 months of replacement therapy,the T3,T4 and TSH of all patients returned to normal range,and the pituitary gland of 18 patients returned to normal size.Conclusion Pituitary enlargement larger than 10 mm should not be easily diagnosed as pituitary adenoma,and pituitary abnormalities with lactation of less than 10mm should not be easily diagnosed as prolactinoma.The diagnosis of pituitary adenoma in all women of childbearing age should be differentiated from pituitary hyperplasia caused by primary hypothyroidism.The examination of T3,T4 and TSH showed that TSH increased significantly without T3 and T4 increased;Long-term replacement therapy for pituitary hyperplasia can achieve good therapeutic effect.

关 键 词：原发性甲减 垂体增生 甲状腺激素 

分 类 号：R736.4[医药卫生—肿瘤]