Giammattei Lorenzo, Maslehaty Homajoun, Petridis Athanasios K, Mehdorn Hubertus Maximilian
Department of Neurosurgery, University of Milan, Fondazione IRCCS Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, Milan, Italy;
Department of Neurosurgery, University Hospitals Schleswig-Holstein, Campus Kiel, Germany University Medical Center, Germany.
Clin Pract. 2011 Jul 1;1(3):e48. doi: 10.4081/cp.2011.e48.
A rare case of infundibulo-neurohypophysitis mimicking a pituitary adenoma is presented. A 69-years-old female patient developed polyuria and polydipsia. Laboratory analysis revealed central diabetes insipidus. No hormonal abnormalities. Cranial-magnetic resonance imaging (MRI) showed a left sided mass in the adenohypophysis presuming a pituitary adenoma. The mass had contact to both internal carotids. Admission to our department for neurosurgical treatment followed. Ophthalmologic examination and neurological examination yielded normal findings. A second MRI focussing on the sellar-region showed a left-sided (T2-MRI.hyperintense), distended adenohypophysis, without contrast enhancement in T1. The stalk appeared thickened. T1-weighted sequences of the neurohypophysis showed loss of signal intensity. We diagnosed an infundibulo-neurohypophysitis and abstained from surgical removal. The patient was discharged under treatment with corticosteroids and desmopressin. Hypophysitis is rare and shows special clinical characteristics. Despite defined radiological features to differentiate between hypophysitis and adenoma the possibility of misdiagnosis, and unnecessary surgical procedures, should always kept in mind.
本文报告了一例罕见的类似垂体腺瘤的漏斗神经垂体炎病例。一名69岁女性患者出现多尿和烦渴症状。实验室分析显示为中枢性尿崩症，无激素异常。头颅磁共振成像（MRI）显示腺垂体左侧有一肿块，考虑为垂体腺瘤。该肿块与双侧颈内动脉均有接触。随后患者入住我科接受神经外科治疗。眼科检查和神经科检查结果均正常。针对鞍区的第二次MRI检查显示左侧（T2-MRI高信号）腺垂体增大，T1加权像无强化。垂体柄增粗。神经垂体的T1加权序列显示信号强度丧失。我们诊断为漏斗神经垂体炎，未进行手术切除。患者在接受皮质类固醇和去氨加压素治疗后出院。垂体炎较为罕见，具有特殊的临床特征。尽管有明确的影像学特征可用于区分垂体炎和腺瘤，但误诊及不必要手术的可能性应始终牢记于心。
