Feigenbaum S L, Martin M C, Wilson C B, Jaffe R B
Department of Obstetrics, Gynecology and Reproductive Sciences, University of California, San Francisco 94143.
Am J Obstet Gynecol. 1991 Jun;164(6 Pt 1):1549-55. doi: 10.1016/0002-9378(91)91435-y.
Lymphocytic adenohypophysitis is a nonneoplastic, autoimmune cause of pituitary enlargement and insufficiency. Forty-eight of the 50 reported cases have occurred in women, nearly all in association with pregnancy. Left undiagnosed and untreated, it can progress to pituitary insufficiency and death. Histologic studies show characteristic changes of autoimmune disease with lymphocytic infiltration and destruction of anterior pituitary tissue with fibrotic replacement. Lymphocytic adenohypophysitis is currently diagnosed after other pituitary mass lesions are excluded and has been treated with a combination of neurosurgery and end-organ hormone replacement. However, with improved knowledge of the pathophysiologic characteristics and natural history of the disease and with the ability to make a prospective diagnosis, we believe glucocorticoids may suppress the inflammatory response and protect remaining pituitary tissue. Two previously unreported pregnancy-associated cases are described, including one prospectively diagnosed and treated without neurosurgery during pregnancy. Obstetrician-gynecologists must place lymphocytic adenohypophysitis in the differential diagnosis of pituitary enlargement associated with pregnancy, since treatment is available and the sequelae may be life-threatening.
淋巴细胞性垂体炎是一种非肿瘤性自身免疫性疾病，可导致垂体增大和功能不全。在已报道的50例病例中，有48例发生在女性身上，几乎所有病例都与妊娠有关。若未得到诊断和治疗，该病可发展为垂体功能不全并导致死亡。组织学研究显示，该病具有自身免疫性疾病的特征性变化，表现为淋巴细胞浸润、垂体前叶组织破坏并被纤维化组织取代。目前，淋巴细胞性垂体炎是在排除其他垂体占位性病变后才得以诊断，并采用神经外科手术和终末器官激素替代联合治疗。然而，随着对该病病理生理特征和自然病程的认识不断提高，以及具备了进行前瞻性诊断的能力，我们认为糖皮质激素可能会抑制炎症反应并保护剩余的垂体组织。本文描述了2例此前未报道的与妊娠相关的病例，其中1例在孕期得到了前瞻性诊断且未接受神经外科手术治疗。妇产科医生必须将淋巴细胞性垂体炎列入与妊娠相关的垂体增大的鉴别诊断中，因为该病有相应的治疗方法，且后遗症可能危及生命。
