Schmidt D N, Wallace K
Allegheny University of the Health Sciences, Philadelphia, USA.
Postgrad Med. 1998 Jul;104(1):77-8, 81-7. doi: 10.3810/pgm.1998.07.532.
Hypopituitarism has many causes and various clinical presentations. Diagnosis depends on history taking, clinical suspicion, and an understanding of the hypothalamic-pituitary-target organ axes for proper interpretation of laboratory data. In the patient described in the case report, amenorrhea and inability to lactate were early clinical clues to a possible pituitary problem, but she felt otherwise fairly well over the years and did not seek evaluation. Thyroid-function tests showed normal thyrotropin measurements, but they were inappropriately low for the low T4 concentrations, indicating pituitary thyrotropin deficiency. Given the patient's obstetric history and overall clinical course, hypopituitarism resulting from postpartum pituitary necrosis was suspected. Magnetic resonance imaging of the pituitary was performed, and she was treated with glucocorticoids, T4 replacement, and estrogen-progesterone replacement. We expected her to do well. In general, the long-term outlook for patients with hypopituitarism is excellent, once the problem is diagnosed. Clinical signs and symptoms should be completely relieved by adequate hormone-replacement therapy, and with proper long-term follow-up and special attention during intercurrent illness, there should be no adverse outcomes.
垂体功能减退有多种病因及不同的临床表现。诊断依赖于病史采集、临床怀疑以及对下丘脑 - 垂体 - 靶器官轴的了解，以便正确解读实验室数据。在病例报告中描述的患者，闭经和无泌乳能力是垂体问题的早期临床线索，但多年来她感觉其他方面相当良好，未寻求评估。甲状腺功能测试显示促甲状腺素测量值正常，但对于低T4浓度而言，该值过低，提示垂体促甲状腺素缺乏。鉴于患者的产科病史和整体临床病程，怀疑是产后垂体坏死导致的垂体功能减退。对垂体进行了磁共振成像检查，并给予她糖皮质激素、T4替代以及雌激素 - 孕激素替代治疗。我们期望她情况良好。一般来说，一旦垂体功能减退问题得到诊断，患者的长期预后良好。通过充分的激素替代治疗，临床体征和症状应完全缓解，并且通过适当的长期随访以及在并发疾病期间给予特别关注，不应出现不良后果。
