Hui Liang, Shijun Hu, Tao Liu, Guoqiang Wen, Shixiong Huang
Department of Neurology, Hainan General Hospital, Haikou, China.
Medicine (Baltimore). 2018 Aug;97(34):e11917. doi: 10.1097/MD.0000000000011917.
Radiation is widely used as the first-line treatment for nasopharyngeal carcinoma (NPC) and improves survival. Nevertheless, radiation also places the patients at risk of radiation-induced adverse effects, such as transient ischemic attack, ischemic stroke, hypopituitarism, and cranial nerve and temporal lobe dysfunction.
A 54-year-old woman who had undergone radiation treatment for NPC 14 years earlier and had no cerebrovascular risk factors, visited our department 4 days after sudden onset of consciousness disturbance. Brain magnetic resonance imaging (MRI) revealed bilateral thalamic and left mesencephalic infarctions with empty sella. Meanwhile, MR angiography showed narrowing in the bilateral posterior cerebral artery. Furthermore, laboratory tests showed low total triiodothyronine (T3), thyroxine (T4), free T3, free T4, luteinizing hormone, estradiol, follicle-stimulating hormone, and serum natrium and normal thyroid-stimulating hormone, which indicated radiation-related hypopituitarism. Serologically, she had low hemoglobin, hematocrit, mean corpuscular volume, mean corpuscular hemoglobin, mean corpuscular hemoglobin concentration, ferritin, and serum iron levels and elevated transferrin, manifesting microcytic anemia. The treatment, including aspirin, atorvastatin, levothyroxine, prednisone, saline infusion, and chalybeate, promoted the patient's recovery.
To our knowledge, this is the first report of bilateral thalamic and mesencephalic infarction together with hypopituitarism following radiotherapy for NPC.
放射治疗广泛用作鼻咽癌（NPC）的一线治疗方法，可提高生存率。然而，放射治疗也会使患者面临辐射诱导的不良反应风险，如短暂性脑缺血发作、缺血性中风、垂体功能减退以及颅神经和颞叶功能障碍。
一名54岁女性，14年前因鼻咽癌接受放射治疗，无脑血管危险因素，在意识障碍突然发作4天后就诊于我院。脑部磁共振成像（MRI）显示双侧丘脑和左侧中脑梗死伴空蝶鞍。同时，磁共振血管造影显示双侧大脑后动脉狭窄。此外，实验室检查显示总三碘甲状腺原氨酸（T3）、甲状腺素（T4）、游离T3、游离T4、黄体生成素、雌二醇、卵泡刺激素及血清钠水平降低，促甲状腺激素正常，提示与放射相关的垂体功能减退。血清学检查显示，她的血红蛋白、血细胞比容、平均红细胞体积、平均红细胞血红蛋白、平均红细胞血红蛋白浓度、铁蛋白及血清铁水平降低，转铁蛋白升高，表现为小细胞性贫血。包括阿司匹林、阿托伐他汀、左甲状腺素、泼尼松、生理盐水输注及铁剂在内的治疗促进了患者的康复。
据我们所知，这是首例鼻咽癌放疗后双侧丘脑和中脑梗死合并垂体功能减退的报告。
