淋巴细胞性垂体炎三例并文献复习_吕朝晖VIP专享VIP免费

作者单位:100853北京,解放军总医院内分泌科通信作者:陆菊明,Emai:llujm@medmai.lcom.cn�论著�淋巴细胞性垂体炎三例并文献复习吕朝晖�陆菊明�金文胜�窦京涛�母义明�潘长玉��【摘要】�目的�提高临床医师对淋巴细胞性垂体炎的认识。方法�分析3例淋巴细胞性垂体炎的临床特点和病理结果。结果�3例患者均为青年女性,例1产后起病,例2和例3在非妊娠或产后期间发病;影像学特点:病变广泛,不仅局限于鞍区和垂体柄,并向下丘脑扩展呈�舌状�改变侵犯海绵窦;增强后病变均匀或环状强化;主要临床表现:(1)垂体功能受损和尿崩症;(2)有局部受压症状,如头痛,视交叉受压;(3)病变侵犯海绵窦,引起动眼、外展神经麻痹;2例经病理证实为淋巴细胞性垂体炎,垂体组织见大量淋巴细胞、浆细胞、组织细胞浸润;2例大剂量甲泼尼龙治疗后,症状明显好转。结论�淋巴细胞性垂体炎亦可发生在非妊娠或产后期间的年轻女性,大剂量甲泼尼龙冲击治疗能有效缩小病变和改善垂体功能。【关键词】�垂体功能减退症;�尿崩症;�糖皮质激素类;�垂体炎,淋巴细胞性Lymphocytichypophysitis:areportof3cases��L�Zhao-hui,LUJu-ming,JINWen-sheng,DOUJing-tao,MUYi-ming,PANChang-yu.DepartmentofEndocrinology,ChinesePLAGeneralHospital,Beijing100853,ChinaCorrespondingauthor:LUJu-ming,Email:lujm@medmail.com.cn【Abstract】�Objective�Lymphocytichypophysitisisarareinflammatorylesionofpituitarygland.Toenhancetheknowledgeoflymphocytichypophysitis,hereinwereported3casesoflymphocytichypophysitisandreviewedtheliterature.Methods�Theclinicaldataof3patientsdiagnosedashavinglymphocytichypophysitiswereanalysed.Results�Allthethreepatientswereyoungfemales,oneofthem(case1)wasaffectedinthepostpartumperiod,however,theotherswereneitherpregnantnorinpostpartumperiod.Clinically,themostfrequentlyseensymptomsandsignswereattributabletopituitaryhypofunction,headacheanddiabetesinsipidus.PituitaryMRIrevealedenhancedmasswithpituitarystalkenlargementexpandingthepituitaryfossa,extendingintosuprasellarareaandcompressingopticchiasm.TypicallythelesionappearedhypointenseorisointenseonT1-weightedimaging,buthyperintenseonT2-weightedimaging.Histopathologicalexaminationshowedextensivedestructionofanterioraciniofthepituitarywithadenseinfiltrationoflymphocytes,plasmacells,histocytesandotherinflammatorycells.Twopatients(case2and3)weresuccessfullytreatedformassreductionofpituitaryglandandrestorationofpituitaryfunctionwithhighdosemethylprednisolonepulsetherapy(HDMPT).Conclusions�Lymphocytichypophysitisisarareautoimmuneendocrinopathywhichcanaffectyoungwomaninthepostpartumperiod,orintheperipartumperiod,characterizedbyfocalorextensivelymphocyticinfiltrationofanteriorpituitaryacin.iItmaycausepituitaryexpansionandavaryingdegreeofhypopituitarismmimickingthefeaturesobservedinpituitaryadenoma.HDMPTwasprovedtobeeffectiveformassreductionofpituitaryglandandrestorationofpituitaryfunction.【Keywords】�Hypopituitarism;�Diabetesinsipidus;�Glucocorticoides;�Hypophysitis,lymphocytic��淋巴细胞性垂体炎是一种少见的自身免疫性内分泌疾病[1,2],以垂体淋巴细胞浸润为特征[3,4],多见于妊娠晚期和产后年轻女性。自1962年首次报道以来,迄今已超过145例[5],国内报道4例[6,7],1例有病理诊断。我院近年诊治3例淋巴细胞性垂体炎,报道如下。临床资料病例1�女,29岁。因头痛2年,闭经2个月伴复视、头晕、恶心1个月于2001年12月11日入院。2001年3月顺产一男婴。体检:血压98/68mmHg(1mmHg=0�133kPa),精神萎靡,左眼外展活动受限,复视。甲状腺不大,心、肺、腹检查未见异常。实�446�中华内科杂志2005年6月第44卷第6期�ChinJInternMed,June2005,Vol44,No.6图1�病例1蝶鞍内垂体组织�HE��200�图2�病例2矢状位T1加...