原发性甲减的垂体MRI及临床表现

The pituitary MRI appearances and clinical symptoms in primary hypothyroidism

目的:报告7例原发性甲减的垂体、蝶鞍核磁共振成像(Magnetic resonance imaging,MRI)表现、临床表现及临床治疗,从而提高对该疾病所致的垂体、蝶鞍MRI表现的认识,特别是对垂体MRI表现的认识,避免误诊的发生。方法:分析7例原发性甲减的垂体、蝶鞍MRI表现、临床表现及临床治疗。结果:本组病例MRI表现特征:垂体增大,酷似肿瘤,上缘隆突其信号表现为等信号,后叶高信号受推压,增强扫描显著强化;蝶鞍扩大,鞍底下移,视交叉受压上抬,鞍背骨质吸收,蝶窦发育差。7例患儿均以身材矮小就诊,临床检验T3、T4均降低,TSH显著增高。经抗甲减治疗1～3月后临床表现明显好转。MRI复查:垂体体积明显缩小。结论:原发性甲减有较典型临床表现,原发性甲减后通过反馈调节,垂体异常增生;颅脑MRI表现为垂体异常增大,此时应密切结合临床表现及生化检查,不要误诊为垂体肿瘤。

Objective：To report the pituitary sella MRI appearances,clinical symptoms and treatment of primary hypothyroidism in 7 cases,in order to improve the recognition of the pituitary sella MRI appearances,especially the MRI appearances of pituitary caused by the primary hypothyroidism,and to avoid misdiagnosis.Methods：The pituitary sella MRI appearances,clinical symptoms and clinical treatment in the primary hypothyroidism in those 7 cases were analyzed.Results：Features of the pituitary sella MRI appearances in those 7 cases：The pituitary increased in size,which appeared like the tumor in extreme.The MRI appearances of the superior carina were intermediate signal intensity,and the posterior lobe of the pituitary,with an obvious enhancement after Gd-DTPA administration,which was compressed by its anterior lobe,were high signal intensity;other MRI features included enlargement of the sella turcica,invasion of its adjacent bones and opticus nervus,and bad development of sphenoid sinus,etc.With T3,T4 decreasing and TSH markedly increasing that was measured by clinical laboratory examination,7 young children with hypothyroidism visited doctor due to a short stature,but their condition had been improved after an anti-hypothyroidism therapy for 1～ 3 months.The MRI features after treatment：The pituitary reduced largely in size.Conclusion：The primary hypothyroidism,with typical clinical symptoms,stimulates the pituitary that grows abnormally by the feedback regulation;it’s highly recommended to pay attention to clinical symptoms and laboratory examination so as to avoid misdiagnosis when the Cerebral MRI appearances mainly shows that the pituitary enlarges abnormally.