Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, South Carolina, USA.
Am J Med Sci. 2011 Sep;342(3):247-9. doi: 10.1097/MAJ.0b013e31821e0e91.
Pituitary dysfunction during pregnancy and its differential diagnosis and treatment can be challenging, as illustrated by the following case. A 22-year-old woman underwent a C-section at 32 weeks of gestation because of preterm labor. She had headache, vision disturbance, polyuria, polydipsia, hypernatremia, diabetes insipidus and a pituitary lesion with findings compatible with apoplexy. Hormonal testing revealed panhypopituitarism. The peripartum presentation, magnetic resonance imaging findings, autoimmunity and global pituitary dysfunction led to the clinical diagnosis of autoimmune lymphocytic hypophysitis. The patient was begun on appropriate hormone replacement therapy. A follow-up magnetic resonance imaging 6 weeks later showed spontaneous regression of the abnormality and a normal-appearing pituitary gland. Thus, acute presentations of pituitary-based pathology during gestation can include previously unrecognized but enlarging tumors, apoplectic hemorrhage and necrosis, and the entity of lymphocytic hypophysitis. A careful evaluation of the clinical, biochemical and radiological characteristics is imperative for accurate diagnosis and proper management to ensure optimal obstetrical outcome.
妊娠期间的垂体功能障碍及其鉴别诊断和治疗颇具挑战性，如下所述的病例即可说明。一位 22 岁的女性因早产而行剖宫产术，妊娠 32 周时出现头痛、视力障碍、多尿、多饮、高钠血症、尿崩症和垂体病变，影像学表现符合垂体卒中。激素检测显示全垂体功能减退。围产期表现、磁共振成像（MRI）结果、自身免疫和全垂体功能障碍导致临床诊断为自身免疫性淋巴细胞性垂体炎。患者开始接受适当的激素替代治疗。6 周后随访 MRI 显示异常自发性消退，垂体外观正常。因此，妊娠期间基于垂体的病变的急性表现可包括以前未被识别但不断增大的肿瘤、卒中性出血和坏死以及淋巴细胞性垂体炎。仔细评估临床、生化和影像学特征对于准确诊断和适当管理至关重要，以确保最佳产科结局。
