妊娠期淋巴细胞性垂体炎合并妊娠期肝内胆汁淤积症1例  

Lymphocytic hypophysitis in pregnancy complicated by intrahepatic cholestasis of pregnancy: a case report

作　　者：李晶[1] 商宇红[1] 纪元[2] 金小涵 李爽[1] 严滨[1] Li Jing;Shang Yuhong;Ji Yuan;Jin Xiaohan;Li Shuang;Yan Bin(Department of Obstetrics and Gynecology,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China;Department of Radiology,the First Affiliated Hospital of Dalian Medical University,Dalian 116011,China)

机构地区：[1]大连医科大学附属第一医院妇产科,大连116011 [2]大连医科大学附属第一医院放射科,大连116011

出　　处：《中华围产医学杂志》2023年第9期769-773,共5页Chinese Journal of Perinatal Medicine

摘　　要：本文报告了1例妊娠期淋巴细胞性垂体炎合并妊娠期肝内胆汁淤积症患者的诊治经过。患者32岁,既往月经规律,自然受孕,妊娠24周出现头痛,无视力视野异常。妊娠32周出现皮肤瘙痒,头痛明显减轻。妊娠33周^(+1)发现总胆汁酸、转氨酶升高及低血糖,诊断为妊娠期肝内胆汁淤积症(轻度)。妊娠33周^(+6)复查总胆汁酸明显升高,因病情迅速进展为妊娠期肝内胆汁淤积症(重度),急诊行剖宫产终止妊娠。新生儿1和5 min Apgar评分分别为5和10分。术后患者无泌乳,出现恶心、呕吐、乏力、顽固性低血钠,血激素测定示腺垂体功能减退,头颅MRI增强扫描示垂体增大、均匀强化,临床诊断为淋巴细胞性垂体炎。患者接受糖皮质激素治疗后症状消失。患者产后1月余恢复月经,产后半年头颅MRI提示病灶消失,继续口服糖皮质激素治疗。This paper reports the diagnosis and treatment of a case of lymphocytic hypophysitis in pregnancy complicated by intrahepatic cholestasis of pregnancy.The 32-year-old patient had regular menstrual cycles and conceived naturally.Around 24 weeks of gestation,she developed a headache without abnormalities in the visual field.Skin itching occurred at 32 weeks of gestation,but her headache was significantly relieved.By 33^(+1) weeks of pregnancy,the patient experienced elevated total bile acid,transaminase,and hypoglycemia,leading to a diagnosis of intrahepatic cholestasis of gestation(mild).Subsequently,at 33^(+6) weeks of gestation,her total bile acid increased substantially,and the disease progressed rapidly into intrahepatic cholestasis of pregnancy(severe).As a result,an emergency cesarean section was performed to terminate the pregnancy.The Apgar score of the newborn was five points at one minute and ten points at five minutes.Following the surgery,the patient showed no lactation and had symptoms such as nausea,vomiting,fatigue,and refractory hyponatremia.Blood hormone measurement showed hypopituitarism.An enhanced intracranial MRI showed pituitary enlargement and uniform enhancement.Consequently,the clinical diagnosis was lymphocytic hypophysitis.Treatment with glucocorticoids effectively alleviated the symptoms.Menstruation resumed after more than one month of delivery.The intracranial MRI in postpartum reexamination after six months of delivery revealed a disappearance of the lesion.The patient continued with oral glucocorticoid therapy.

关 键 词：妊娠并发症 自身免疫性垂体炎 胆汁淤积 肝内 

分 类 号：R714.25[医药卫生—妇产科学]