Hatake K, Kubota A, Taniguchi T, Negoro M, Ouchi H, Minami T, Hishida S
Department of Legal Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
Nihon Hoigaku Zasshi. 1994 Aug;48(4):267-73.
We report a 29-year-old woman who died due to pituitary insufficiency. After a normal delivery 2 years previously, she had suffered from amenorrhea and displayed decreased libido. She was discovered in convulsions by her husband when he returned home, and was admitted to an emergency hospital. Despite various treatments, she died. Her blood glucose level on admission was low, 32 mg/dl. Autopsy findings showed thin public hair and almost no axillary hair. The right and left adrenal glands weighed 1.7 g and 1.2 g, respectively. Histologically, the anterior pituitary gland showed severe bleeding and necrosis, and the middle lobe showed lymphocytic infiltration; the posterior lobe was almost normal. The adrenal glands showed marked atrophy of the cortex and deposition of calcium in the medulla. The thyroid gland, which weighted 15 g, showed diffuse interstitial lymphocytic infiltration, indicative of chronic lymphocytic thyroiditis. Atrophy of the ovaries and uterine endometrium was also observed. These findings indicated that death had been due to pituitary insufficiency. The histopathology of the pituitary, which showed lymphoid hypophysitis, and its association with lymphoid thyroiditis suggested that the pituitary insufficiency was not due to ischemic injury after delivery, a condition which can result from massive hemorrhage, but rather had arisen as a result of an autoimmune process.
我们报告了一名29岁因垂体功能不全死亡的女性。两年前她顺产之后，出现闭经且性欲减退。她丈夫回家时发现她抽搐，遂被送往急诊医院。尽管接受了各种治疗，她还是去世了。入院时她的血糖水平很低，为32mg/dl。尸检结果显示阴毛稀疏且几乎没有腋毛。左右肾上腺分别重1.7g和1.2g。组织学检查显示，垂体前叶有严重出血和坏死，中叶有淋巴细胞浸润；后叶基本正常。肾上腺显示皮质明显萎缩，髓质有钙沉积。重15g的甲状腺有弥漫性间质淋巴细胞浸润，提示慢性淋巴细胞性甲状腺炎。还观察到卵巢和子宫内膜萎缩。这些发现表明死亡原因是垂体功能不全。垂体的组织病理学表现为淋巴细胞性垂体炎，且与淋巴细胞性甲状腺炎相关，这表明垂体功能不全并非分娩后缺血性损伤所致（分娩后缺血性损伤可由大量出血引起），而是自身免疫过程导致的。
