Yoshioka M, Yamakawa N, Saito H, Yoneda M, Nakayama T, Kuroki M, Tsuchida T, Sekiya M
Department of Internal Medicine, Niigata Prefectural Central Hospital, Joetsu, Japan.
Intern Med. 1992 Sep;31(9):1147-50. doi: 10.2169/internalmedicine.31.1147.
We report an unusual case of granulomatous hypophysitis in which visual impairment, meningitis and hypopituitarism in a 76-year-old female were associated with radiological evidence of a pituitary mass. The sellar lesion was indistinguishable from pituitary tumor on neuroimaging studies, but the recovery of visual acuity and visual field abnormalities together with the improvement of pituitary function after steroid administration indicated that the mass lesion was due to an inflammatory disease of the pituitary gland. The pituitary tissue obtained by transsphenoidal hypophysectomy revealed granulomatous inflammatory cell infiltration with epithelioid cells and scattered multinucleated giant cells. Although a causal relationship with meningitis was not ascertained, possible exposure of the CSF space to the autoimmune inflammatory process of the pituitary gland was likely in view of the positive pituitary antibody reaction and radiological evidence of suprasellar extension. This entity should be considered when evaluating patients with a pituitary mass, hypopituitarism and meningitis.
我们报告了一例罕见的肉芽肿性垂体炎病例，一名76岁女性出现视力障碍、脑膜炎和垂体功能减退，同时影像学检查显示垂体有肿块。鞍区病变在神经影像学研究中与垂体肿瘤难以区分，但给予类固醇后视力和视野异常恢复，垂体功能改善，表明肿块病变是由垂体的炎症性疾病引起的。经蝶窦垂体切除术获取的垂体组织显示有肉芽肿性炎性细胞浸润，伴有上皮样细胞和散在的多核巨细胞。虽然未确定与脑膜炎的因果关系，但鉴于垂体抗体反应阳性及鞍上扩展的影像学证据，脑脊液间隙可能暴露于垂体的自身免疫性炎症过程。在评估有垂体肿块、垂体功能减退和脑膜炎的患者时应考虑到这一疾病。
