Masana Y, Ikeda H, Fujimoto Y, Matsumura I, Kawakami F, Mori S, Arita N, Ushio Y
Department of Neurosurgery, Itami Municipal Hospital, Hyogo.
Neurol Med Chir (Tokyo). 1990;30(11 Spec No):853-7. doi: 10.2176/nmc.30.853.
The patients was a 27-year-old female, gravida 0, para 0, with complaint of headache and visual disturbance for about 1 month. Ophthalmological examination showed impaired visual acuity and enlargement of Mariotte's spot on the left. A computed tomography scan disclosed an enhanced mass in the sellar and suprasellar region. Endocrinological examination revealed slight elevation of thyroxin, growth hormone, and prolactin. A trans-sphenoidal hypophysectomy was carried out with a preoperative diagnosis of nonfunctioning pituitary adenoma. Histological examination showed a marked infiltration of lymphocytes and interstitial fibrosis, diagnosed as lymphocytic adenohypophysitis. She received hormone-replacement therapy owing to postoperative hypopituitarism. Twenty-eight cases of lymphocytic adenohypophysitis including the author's are classified clinically into two types; fulminant type and chronic type. The former type occurs frequently with disturbance of consciousness because of the end organ insufficiency and proceeds to death in a fulminant course. The latter type occurs frequently with headache and visual disturbances, closely related to pregnancy and the postpartum period and survival occurs with hormone replacement therapy. This disease should be kept in mind in the diagnosis of sellar and suprasellar mass lesions.
患者为一名27岁女性，孕0产0，主诉头痛及视力障碍约1个月。眼科检查显示视力受损，左侧生理盲点扩大。计算机断层扫描显示蝶鞍和鞍上区域有强化肿块。内分泌检查显示甲状腺素、生长激素和催乳素略有升高。术前诊断为无功能垂体腺瘤，遂行经蝶窦垂体切除术。组织学检查显示淋巴细胞明显浸润和间质纤维化，诊断为淋巴细胞性垂体炎。由于术后垂体功能减退，她接受了激素替代治疗。包括作者的病例在内，28例淋巴细胞性垂体炎临床分为两型：暴发型和慢性型。前一型常因终末器官功能不全出现意识障碍，呈暴发性病程并导致死亡。后一型常伴有头痛和视力障碍，与妊娠及产后期密切相关，经激素替代治疗可存活。在诊断蝶鞍和鞍上肿块病变时应考虑到这种疾病。
