Vesely D L, Mastrandrea P, Samson C, Argyelan G, Charvit S
Department of Internal Medicine, University of South Florida for Health Sciences, and James A. Haley Veterans Hospital, Tampa 33612, USA.
Am J Med Sci. 2000 Oct;320(4):273-7. doi: 10.1097/00000441-200010000-00008.
A 49-year-old man with herpes simplex encephalitis at age 22 was admitted with hypotension (90/60 mm Hg) and hypothermia (33.7 degrees C). His blood pressure was 80-90/50-60 mm Hg, with temperatures averaging 35 degrees C, for at least 3 years before admission. Evaluation of his hypothermia and hypotension revealed a low free triiodothyronine, low normal thyrotropin, luteinizing hormone < 2 mIU/L, follicle stimulating hormone <3 mIU/L, and low testosterone of 1.39 ng/dL. A baseline cortisol of 13.9 microg/dL was stimulated to 41.8 microg/dL with corticotropin, indicating he had partial anterior hypopituitarism with an intact pituitary-adrenal axis. Posterior pituitary function was normal. MRI revealed a "bright" posterior pituitary on a T1-weighted image, further indicating a normal posterior pituitary. Extensive decreased T1-weighting on MRI in the right and left temporal lobes was consistent with encephalomalacia. With thyroid hormone replacement, his blood pressure increased to 110/70 mm Hg with a temperature of 37 degrees C.
一名49岁男性，22岁时患单纯疱疹性脑炎，因低血压（90/60 mmHg）和体温过低（33.7℃）入院。入院前至少3年，他的血压为80 - 90/50 - 60 mmHg，体温平均为35℃。对其体温过低和低血压的评估显示，游离三碘甲状腺原氨酸水平低，促甲状腺激素水平略低于正常，促黄体生成素<2 mIU/L，促卵泡生成素<3 mIU/L，睾酮水平低至1.39 ng/dL。基础皮质醇水平为13.9 μg/dL，使用促肾上腺皮质激素刺激后升至41.8 μg/dL，表明他存在部分垂体前叶功能减退，但垂体 - 肾上腺轴完整。垂体后叶功能正常。MRI在T1加权图像上显示垂体后叶“明亮”，进一步表明垂体后叶正常。MRI显示左右颞叶广泛的T1加权降低，与脑软化相符。经过甲状腺激素替代治疗后，他的血压升至110/70 mmHg，体温升至37℃。
