Asano Tomoko, Yamada Hodaka, Yoshida Masashi, Aoki Atsushi, Ikoma Aki, Kusaka Ikuyo, Toyoshima Hideo, Kakei Masafumi, Ishikawa San-E
Department of Medicine, Jichi Medical University Saitama Medical Center, Japan.
Intern Med. 2015;54(8):935-40. doi: 10.2169/internalmedicine.54.3289. Epub 2015 Apr 15.
A 73-year-old woman was admitted due to weight loss and generalized malaise. The basal levels of all the anterior pituitary hormones, except for prolactin, were reduced. However, they were all elevated in response to exogenous hypothalamic hormones. After starting hydrocortisone replacement, the patient had polyuria of >5,000 mL/day. T1-weighted MRI depicted a low signal of an oval mass in the sella turcica and an iso-intense signal of another mass at the pituitary stalk. These findings indicate a hypothalamic type of hypopituitarism and masked central diabetes insipidus which possibly derived from the atypical occupation of Rathke's cleft cyst at the pituitary stalk.
一名73岁女性因体重减轻和全身不适入院。除催乳素外，所有垂体前叶激素的基础水平均降低。然而，它们对外源性下丘脑激素均有升高反应。开始氢化可的松替代治疗后，患者出现每日尿量>5000 mL的多尿症状。T1加权磁共振成像显示蝶鞍内椭圆形肿块呈低信号，垂体柄处另一肿块呈等信号。这些发现提示为下丘脑型垂体功能减退症，并掩盖了中枢性尿崩症，这可能源于垂体柄处Rathke裂囊肿的非典型占位。
