小儿垂体增生误诊垂体腺瘤

Misdiagnosis on pituitary hyperplasia and pituitary adenoma of children

目的观察小儿垂体增生的临床特点和药物治疗后垂体影像学检查的变化。方法分析8例影像学检查显示"垂体增大,不能除外垂体腺瘤"的内分泌紊乱儿童的临床、MRI特点及激素替代治疗效果。结果 8例均存在明显的内分泌功能紊乱所致的临床症状和体征,以性早熟和甲状腺功能低下为主,无明显的颅内占位或侵袭症状。内分泌检查与临床吻合。颅脑MRI均提示垂体增大,部分病例平扫或增强信号不均匀,疑诊"垂体腺瘤"。予相应激素替代治疗后3个月,复查垂体明显缩小或正常,间隔3个月再随诊垂体未见异常改变。结论提示小儿垂体增生易与垂体腺瘤误诊,应重视临床特点和内分泌检查,必要时应用相应激素治疗后复查,避免不必要的手术治疗。

Objective To observe and analyze the clinical features of pituitary hyperplasia and the imaging change of pituitary after drug treatment on pediatric patients.Methods Analyzed the clinical and MRI features and the effect of hormone replacement therapy on 8 cases of endocrine disordered pediatric patients who were diagnosed ＂pituitary increased,and cannot rule out the possibility of pituitary gland adenoma＂.Results All of the 8 cases showed obvious clinical symptom and sign of endocrine function disorder,mainly sexual precocity and hypothyroidism but no apparent intracranial space occupying lesion symptom.Endocrine examination was consistent with clinical manifestation.Brain MRI suggested that pituitary enlarged and part of cases showed unevenness on plain CT scan or signal enhancement and pituitary adenoma was suspected.After hormone substitution treatment for three months,reexamination showed that the pituitary gland obviously reduced or even returned to normal,and another three months later,follow up clinic showed no exceptional change on pituitary gland.Conclusion The result suggests that the young child pituitary gland proliferation and the pituitary adenoma are easily to be misdiagnosed.Therefore,clinical features and endocrine inspection should be paid enough attention.After hormone substitution treatment,necessary reexamination should be taken in order to avoid unnecessary surgical therapy.