腺垂体功能减退症患者260例临床分析

Clinical analysis of 260 cases of hypopituitarism

目的探讨腺垂体功能减退症临床特点及病因诊断与鉴别。方法同顾性分析我院2007年1月至2011年9月收治的共260例腺垂体功能减退症患者的临床资料。结果260例中，男性96例、女性164例，女性发病年龄（44±16）岁，明显高于男性的（32±20）岁，两者比较差异有统计学意义（t=3．821，P=0．001）。男性20岁以前发病者所占比例最高，为39．6％（38例），女性以40-60岁所占比例最高，为52．4％（86例）；最常见病因为垂体瘤及其术后损伤共94例（36．2％），其次为席汉综合征86例（33．1％）；最常见临床表现为贫血（102例），26例患者表现为全腺垂体功能减退；大多数病因导致的腺垂体功能减退症均具有特异性垂体影像学表现；误诊率为40．4％（105／260），病冈诊断时误诊率为25．4％（66／260）。结论腺垂体功能减退症女性40-60岁、男性20岁以下者居多，病因以垂体瘤及其手术损伤最多，贫血为最常见的临床表现，误诊率较高。通过病史、临床表现及垂体影像学检查，可做出诊断与鉴别。

Objective To review the clinical features, etiology and differential diagnosis of hypopituitarism. Methods The clinical data of 260 patients with hypopituitarism admitted to our hospital during 2007 to 2011 were retrospectively analyzed. Results In 260 patients 96 were males and 164 were females, the average age of female patients was significantly higher than that of malesI （44 - 16） vs. （32 -＋ 20） years; t = 3. 821, P =0. 001 ]. Patients under 20 years accounted for the highest proportion in male cases （38/96, 39.6% ） ; while patients aged 40 - 60 years were the highest proportion for female cases （86/164, 52.4%）. Pituitary tumor and postoperative damage was the most common cause for hypopituitarism accounting for 36. 2% （94/260）, followed by Sheehan syndrome （86/260, 33.1% ）. The most common manifestation of hypopituitarism was anemia （ 102 eases） ; 26 eases presented all pituitary function failure. The causes leading to hypopituitarism usually showed specific manifestations in imaging examinations. The overall misdiagnosis rate was 40. 4% （105/260）in this series, while that of etiological diagnosis was 25.4% （66/260）. Conclusions This study suggests that hypopituitarism caused by different causes can be diagnosed by disease history, clinical manifestafions and pituitary imaging examination.