Fujimaki Takamitsu, Hotta Shinji, Mochizuki Toshihiro, Ayabe Takuya, Matsuno Akira, Takagi Kiyoshi, Nakagomi Tadayoshi, Tamura Akira
Departments of Neurosurgery, Teikyo University School of Medicine, Kaga, Japan.
Neurol Res. 2005 Jun;27(4):399-402. doi: 10.1179/016164105X17341.
A patient with pituitary apoplexy resulting from lymphocytic adenohypophysitis, which caused visual disturbance during pregnancy, is described. This is the first report of such case.
A 23-year-old primigravida in her 25th week of gestation experienced headache and bitemporal hemianopsia of sudden onset. Magnetic resonance imaging (MRI) revealed a large pituitary mass with intratumoral hemorrhage. Although conservative treatment with intravenous glycerol improved the symptoms partially, the visual symptoms worsened again 6 weeks later. After delivering a girl by scheduled caesarean section her visual symptoms improved. Despite the symptomatic improvement, MRI showed the chiasmatic compression by the enlarged pituitary gland had not changed. Therefore, trans-sphenoidal surgery to decompress the chiasm was performed. Necrotic tissue was seen exuding behind the enlarged pituitary gland and adenohypophysitis with bleeding (apoplexy) was diagnosed histologically. After follow-up for 40 months, she was doing well without any visual or neurological deficits.
Although relatively rare, pituitary apoplexy as a consequence of lymphocytic adenohypophysitis should be borne in mind when a pregnant woman presents with headache and visual disturbance of sudden onset.
本文描述了一名因淋巴细胞性垂体炎导致垂体卒中的患者，该患者在孕期出现了视力障碍。这是此类病例的首例报告。
一名23岁初产妇，孕25周时突然出现头痛和双颞侧偏盲。磁共振成像（MRI）显示垂体有一个大肿块伴瘤内出血。尽管静脉输注甘油进行保守治疗使症状部分改善，但6周后视觉症状再次恶化。经 scheduled caesarean section（择期剖宫产）产下一名女婴后，她的视觉症状有所改善。尽管症状有所改善，但MRI显示扩大的垂体对视交叉的压迫并无变化。因此，进行了经蝶窦手术以减压视交叉。在扩大的垂体后方可见坏死组织渗出，组织学诊断为伴有出血（卒中）的淋巴细胞性垂体炎。随访40个月后，她情况良好，无任何视觉或神经功能缺损。
尽管相对罕见，但当孕妇突然出现头痛和视觉障碍时，应考虑淋巴细胞性垂体炎导致垂体卒中的可能性。
