Nishioka H, Ito H, Sano T, Ito Y
Department of Neurosurgery, Tokyo Medical College, Japan.
Surg Neurol. 1996 Sep;46(3):285-90; discussion 290-1. doi: 10.1016/0090-3019(96)00161-9.
It has been thought that neurohypophysial involvement manifesting as central diabetes insipidus in lymphocytic hypophysitis is uncommon. Although cases with such an association have been reported recently with increasing frequency, the relationship with lymphocytic infundibular neurohypophysitis remains unclear.
Two postmenopausal women who presented with diabetes insipidus are reported. Adenohypophysial function was normal in both cases, apart from growth hormone secretion. Magnetic resonance imaging revealed a sellar mass lesion mimicking pituitary adenoma, with loss of the hyperintense signal of the neurohypophysis in both cases and thickening of the stalk in one case. The lesion was located behind the residual adenohypophysis during transsphenoidal biopsy; however, histologic examination showed chronic inflammation of the adenohypophysis, findings identical to those of lymphocytic adenohypophysitis. Although the principal site of the inflammation was considered to be the neurohypophysial system, adenohypophysis was also involved in the lesion. We suggest that these cases represent a variant of lymphocytic infundibular neurohypophysitis.
To avoid unnecessary surgical intervention, it is important to note that some variants of lymphocytic infundibulo-neurohypophysitis may form a mass lesion not localized in the neurohypophysial system but involving the adenohypophysis, thus resembling adenomas and other tumors.
一直以来，人们认为淋巴细胞性垂体炎中表现为中枢性尿崩症的神经垂体受累情况并不常见。尽管最近有越来越多关于这种关联病例的报道，但与淋巴细胞性漏斗神经垂体炎的关系仍不明确。
报告了两名出现尿崩症的绝经后女性。除生长激素分泌外，两例患者的腺垂体功能均正常。磁共振成像显示鞍区有占位性病变，类似垂体腺瘤，两例患者的神经垂体高信号均消失，其中一例患者的垂体柄增粗。经蝶窦活检时，病变位于残留腺垂体后方；然而，组织学检查显示腺垂体有慢性炎症，这与淋巴细胞性腺垂体炎的表现相同。尽管炎症的主要部位被认为是神经垂体系统，但腺垂体也参与了病变。我们认为这些病例代表了淋巴细胞性漏斗神经垂体炎的一种变体。
为避免不必要的手术干预，重要的是要注意到淋巴细胞性漏斗神经垂体炎的某些变体可能形成并非局限于神经垂体系统而是累及腺垂体的占位性病变，从而类似腺瘤和其他肿瘤。
