Panigrahi Manas, Kumari Manoranjitha, Vooturi Sudhindra
Department of Neurosurgery, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India.
Department of Neurology, Krishna Institute of Medical Sciences, Secunderabad, Telangana, India.
Neurol India. 2018 Mar-Apr;66(2):400-404. doi: 10.4103/0028-3886.227293.
The diagnosis of lymphocytic hypophysitis (LYH) is a clinical challenge. Medical management with steroids may result in complete resolution of the symptoms and radiological features. We report our approach to the diagnosis and treatment of LYH.
Retrospective analysis of data of nine consecutive patients of LYH from August 2013 to August 2015 was done. The average age of the study population was 38.4 ± 19.8 years, with five (55.5%) women. Presumptive diagnosis of LYH was made in six patients who were treated with steroids. Among the medical intervention group, one patient developed progressive ocular symptoms involving the third cranial nerve, which required surgical intervention. Out of the five remaining patients under medical treatment, four patients showed improvement in clinical symptoms and resolution of radiological features and one patient showed recurrence of the lesion. In the surgical group, the diagnosis was made after the histopathological confirmation.
: In the surgical group, the diagnosis was made after the histopathological confirmation in all patients except one. All the patients in this group presented with optic nerve compression requiring surgical decompression. All the patients in this group showed symptomatic improvement postoperatively. Symptoms for deficiency of hormones required supplementation dose of steroids.
: Steroids should be considered as the first line of management in LYH. Surgical resection should be considered in the presence of optic nerve and/or chiasmal compression and for lesions nonresponsive to medical management.
淋巴细胞性垂体炎（LYH）的诊断是一项临床挑战。使用类固醇进行药物治疗可能会使症状和影像学特征完全缓解。我们报告我们对LYH的诊断和治疗方法。
对2013年8月至2015年8月连续9例LYH患者的数据进行回顾性分析。研究人群的平均年龄为38.4±19.8岁，其中5例（55.5%）为女性。6例接受类固醇治疗的患者被初步诊断为LYH。在药物干预组中，1例患者出现累及动眼神经的进行性眼部症状，需要手术干预。在其余5例接受药物治疗的患者中，4例患者的临床症状有所改善，影像学特征消失，1例患者病变复发。在手术组中，经组织病理学确诊后做出诊断。
在手术组中，除1例患者外，所有患者均经组织病理学确诊。该组所有患者均表现为视神经受压，需要手术减压。该组所有患者术后症状均有改善。激素缺乏症状需要补充类固醇剂量。
类固醇应被视为LYH治疗的一线用药。在存在视神经和/或视交叉受压以及对药物治疗无反应的病变时，应考虑手术切除。
