中国全科医学2017，Vol.20Issue(2)：224-227,4.DOI:10.3969/j.issn.1007-9572.2017.02.021
淋巴细胞性垂体炎五例临床诊疗分析
Clinical Diagnosis and Treatment Analysis of Five Cases with Lymphocytic Hypophysitis
摘要
Abstract
Objective According to the analysis of the clinical data of patients with lymphocytic hypophysitis(LyH), to discuss their diagnosis and treatment methods and to improve clinical knowledge and levels of diagnosis and treatment. Methods Five patients who were clinically diagnosed with LyH in the First Affiliated Hospital of Zhengzhou University in 2015 were selected,and the clinical data,such as clinical manifestation,findings of endocrine and imageological examination, treatment and prognosis were collected. Results Of the 5 patients,3 were male and 2 were female;aged from 17 to 41,and with the course of disease ranged from 7 days to 9 years. Four patients exhibited polyphagia and polyuria,2 had nausea and vomiting,2 had decreased libido,1 presented with amenorrhea,1 with dizziness and headache. Two patients had normal levels of adrenocorticotrophic hormone - cortisol(ACTH - COR),3 had decreased level of ACTH - COR;2 patients presented with elevated prolactin( PRL)levels,2 with decreased PRL levels,and 1 with normal level of PRL;2 patients had normal luteinizing hormone(LH)and follicle stimulating hormone( FSH),and 3 with decreased LH and FSH;and 2 patients had hypothyroidism. Pituitary magnetic resonance imaging(MRI)showed that pituitary stalk of 5 patients were enlarged,pituitary of 3 were widespread enlarged,optic chiasm of 2 were affected,and 2 had loss of neurohypophysis bright signal. Four patients with polydipsia and polyuria received water - depriving pressure test,and all met with signs of central diabetes insipidus,pituitary MRI showed that two patients had neurohypophysis bright signal. Patients were treated with glucocorticoid of different doses and courses,patients with hypothyroidism were given levothyroxine sodium tablets,and patients with central diabetes insipidus were given desmopressin acetate tablets. The symptoms of the patients were relieved at varying degrees,but all of them did not return to normal,and 1 patient had femoral head necrosis. Conclusion The main imaging feature of LyH is thickening pituitary stalk;MRI is the simple and effective method of diagnosing and evaluating the treatment effect of the disease;central diabetes insipidus contributes to the identification of pituitary tumors,glucocorticoid treatment is effective in this disease,but its adverse reactions should be on the alert.关键词
垂体疾病/垂体柄/尿崩症,神经性/磁共振成像/糖皮质激素类Key words
Pituitary diseases/Pituitary stalk/Diabetes insipidus, neurogenic/Magnetic resonance imaging/Glucocorticoids分类
医药卫生引用本文复制引用
王志芳,崔西春,张丽侠,栗夏莲,郑丽丽..淋巴细胞性垂体炎五例临床诊疗分析[J].中国全科医学,2017,20(2):224-227,4.基金项目
河南省教育厅科学技术研究重点项目 （）
