高龄多发性骨髓瘤鞍区占位1例  

Sellar multiple myeloma in an elderly patient:a case report

作　　者：陈晓雪 段炼 柯晓安 阳洪波 潘慧 朱惠娟 王林杰 CHEN Xiaoxue;DUAN Lian;KE Xiaoan;YANG Hongbo;PAN Hui;ZHU Huijuan;WANG Linjie(Department of Endocrinology,Key Laboratory of Endocrinology of National Health Commission,Peking Union Medical College Hospital,CAMS&PUMC,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院内分泌科,国家卫生健康委员会内分泌重点实验室,北京100730

出　　处：《基础医学与临床》2025年第1期98-101,共4页Basic and Clinical Medicine

基　　金：中央高水平医院临床科研业务费资助(2022-PUMCH-A-064)。

摘　　要：目的通过总结1例高龄多发性骨髓瘤鞍区占位患者的临床特点,增加对此类疾病的认识。方法回顾性分析1例高龄多发性骨髓瘤鞍区占位患者的临床表现、生化检验、影像学资料。结果患者为85岁男性,主要临床表现为乏力、纳差、多尿。辅助检查提示血钠明显降低、轻度高总蛋白及垂体占位、多项垂体前叶激素水平下降、泌乳素水平升高。完善病因筛查时发现血免疫球蛋白G(IgG)水平显著升高,血M蛋白阳性,骨髓涂片示骨髓瘤细胞,同时伴有全身骨骼多发溶骨性病变,考虑多发性骨髓瘤诊断明确,垂体占位为髓外受累可能性大。结论鞍区占位病因多样,多发性骨髓瘤鞍区受累发生率低,起病隐匿,临床特征、影像学表现缺乏特异性,易造成误诊及漏诊。Objective To investigate the clinical characteristics in an elderly patient with sellar multiple myeloma.Methods Clinical features,laboratory data and radiologic profile of an elderly patient with sellar multiple myeloma were collected.Results The patient was an 85-year-old male.The main clinical manifestations were fatigue,poor appetite and polyuria.Laboratory examinations showed a significant decrease in blood sodium,several anterior pituitary hormones and an increase in total protein,mass of pituitary lesion and concentration of prolactin.During etiological screening,it was found that the blood immunoglobulin G(IgG)level was significantly increased,the blood M protein was positive and the bone marrow smear showed myeloma cells accompanied by multiple osteolytic lesions in the bones of the whole body.Considering the diagnosis of multiple myeloma,the pituitary lesion was likely to be the extra-medullary involvement.Conclusions The intrasellar plasmacytoma is not common.The disease onset is insidious with clinical features and imaging findings lacking specificity.Therefore,diagnosis relies on biopsy which poses risks for elderly patients and increases diagnostic challenges leading to misdiagnosis.

关 键 词：多发性骨髓瘤 鞍区占位 鞍内浆细胞瘤 高龄 

分 类 号：R584[医药卫生—内分泌]