학술논문
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
Document Type
Academic Journal
Author
Source
中国全科医学. 20(2):224-227
Subject
Language
Chinese
ISSN
1007-9572
Abstract
目的：通过分析淋巴细胞性垂体炎（LyH）患者临床资料探讨其诊治方法，提高对其临床认识和诊治水平。方法选取2015年郑州大学第一附属医院临床诊断为 LyH 患者5例，收集临床表现、内分泌及影像学检查结果、治疗、转归等临床资料。结果5例患者中男3例，女2例；年龄17～41岁；病程7 d ～9年。4例患者出现多饮、多尿，2例出现恶心、呕吐，2例出现性欲减退，1例出现闭经，1例出现头晕、头痛。2例患者促肾上腺皮质激素-皮质醇（ACTH - COR）水平正常，3例 ACTH - COR 水平降低；2例患者泌乳素（PRL）水平升高，2例 PRL 水平降低，1例 PRL 水平正常；2例患者促黄体生成素（LH）、卵泡刺激素（FSH）水平正常，3例 LH、FSH 水平降低；2例患者甲状腺功能减退。垂体磁共振成像（MRI）示5例患者垂体柄增粗，3例垂体弥漫性增大，2例累及视交叉，2例神经垂体高信号消失。4例多饮、多尿患者行禁水加压试验均符合中枢性尿崩症，其中2例患者垂体 MRI 示神经垂体高信号存在。患者均给予不同剂量和疗程糖皮质激素治疗，甲状腺功能减退者给予左甲状腺素钠片，中枢性尿崩症患者给予醋酸去氨加压素片。患者症状均有不同程度的缓解，但均未恢复至正常，1例出现股骨头坏死。结论 LyH 主要影像学特点为垂体柄增粗，MRI 是该疾病诊断和评估治疗效果简单、有效的方法，中枢性尿崩症有助于与垂体瘤鉴别，糖皮质激素治疗对该疾病有效，但应警惕其不良反应。
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.
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.