Reyes S Pablo, Andreu Daniel, Toledo Camila
Departamento de Ciencias Neurológicas Oriente, Universidad de Chile, Santiago, Chile.
Servicio de Neurología, Neurocirugía y Neurorradiología, Clínica Santa María, Santiago, Chile.
Rev Med Chil. 2020 Feb;148(2):258-262. doi: 10.4067/s0034-98872020000200258.
Primary lymphocytic hypophysitis is an autoimmune disease characterized by lymphocytic infiltration of the pituitary gland, with a higher incidence during late pregnancy and the postpartum period. It causes glandular destruction, mass effect and symptoms such headache, visual field defects, ophthalmoplegia and symptoms of hypopituitarism. We report a 38-year-old postpartum woman who, after giving birth presented decreased left visual acuity associated with a non ictal headache. Magnetic resonance imaging demonstrated a sellar mass associated with decreased free thyroxine and cortisol levels. Suspecting a primary lymphocytic hypophysitis, she was treated with prednisone 60 mg/day and hormonal replacement therapy. One month later, size of the pituitary gland decreased, and the visual field defect improved. Steroidal treatment was maintained for 36 months and progressively tapered. After two years of follow-up, the imaging studies show a normal sized pituitary gland.
原发性淋巴细胞性垂体炎是一种自身免疫性疾病，其特征为垂体淋巴细胞浸润，在妊娠晚期和产后发病率较高。它会导致腺组织破坏、占位效应以及诸如头痛、视野缺损、眼肌麻痹和垂体功能减退等症状。我们报告一例38岁的产后女性，分娩后出现左眼视力下降并伴有非发作性头痛。磁共振成像显示鞍区肿块，同时游离甲状腺素和皮质醇水平降低。怀疑为原发性淋巴细胞性垂体炎，给予她泼尼松60毫克/天治疗及激素替代疗法。1个月后，垂体大小减小，视野缺损改善。激素治疗维持36个月并逐渐减量。随访两年后，影像学检查显示垂体大小正常。
