Jennings A M, Robinson A, Kandler R H, Betts R P, Ryder R E, Cullen D R
Department of Endocrinology, Royal Hallamshire Hospital, Sheffield, UK.
Clin Endocrinol (Oxf). 1993 Jul;39(1):113-8. doi: 10.1111/j.1365-2265.1993.tb01760.x.
We report two patients with treated pituitary gigantism and peripheral neuropathy, one of whom has chronic foot ulceration. Detailed neurophysiological assessment was performed on both patients. The patient with foot ulceration had clinical and neurophysiological evidence of severe neuropathy, whereas the patient without ulceration had only neurophysiological abnormalities. The sweating response to acetylcholine was markedly impaired in the feet of both patients, suggesting pedal autonomic denervation. Neither patient had evidence of diabetes mellitus and detailed investigation failed to reveal an alternative cause of peripheral neuropathy. Optical pedobarography revealed abnormally high pressure (> 10 kg/cm2) under the metatarsal heads of both patients, one such area coinciding with the area of ulceration. Thus in pituitary gigantism elevated plantar pressures may contribute to the development of foot ulceration when severe peripheral neuropathy is present. Furthermore, as in diabetes mellitus, impaired sweating may also increase the risk of ulceration as the resultant dry skin may develop fissures.
我们报告了两名接受治疗的垂体性巨人症合并周围神经病变患者，其中一名有慢性足部溃疡。对两名患者均进行了详细的神经生理学评估。有足部溃疡的患者有严重神经病变的临床和神经生理学证据，而无溃疡的患者仅有神经生理学异常。两名患者足部对乙酰胆碱的出汗反应均明显受损，提示足部自主神经去神经支配。两名患者均无糖尿病证据，详细检查未发现周围神经病变的其他原因。光学足底压力测定显示两名患者跖骨头下压力异常高（>10kg/cm²），其中一个这样的区域与溃疡区域重合。因此，在垂体性巨人症中，当存在严重周围神经病变时，足底压力升高可能导致足部溃疡的发生。此外，与糖尿病一样，出汗受损也可能增加溃疡风险，因为由此导致的皮肤干燥可能会出现裂缝。
