误诊为原发性淋巴细胞性垂体炎四例分析

An analysis of four cases of misdiagnosed primary lymphocytic hypophysitis

回顾性分析4例误诊为淋巴细胞性垂体炎（LYH）病例的临床、影像、病理资料及诊治经过,以提高鞍区病变的鉴别诊断能力.4例患者年龄20 -60岁,男2例,女2例;均有头痛、多饮、多尿等症状;功能评价显示为中枢性尿崩症和垂体前叶功能低下;鞍区MRI均显示为与LYH相似病变;均在糖皮质激素冲击治疗部分改善后短期内出现原有症状加重,手术病理诊断分别为颅咽管瘤伴感染、垂体脓肿、Wegener肉芽肿合并继发性垂体炎和生殖细胞瘤.对于疑诊为LYH的患者,如果糖皮质激素治疗不缓解或部分缓解短期内又恶化者应及时行活检或手术以明确诊断.

To improve the differential diagnosis of sellar region mass,4 cases with sellar mass and misdiagnosed as lymphocytic hypophysitis （LYH） were reviewed retrospectively.The 4 patients （2 male and 2 female） aged 20-60 years old were all presented with symptoms of headache,polydipsia and polyuria.Biochemical studies confirmed the diagnoses of central diabetes insipidus and hypopituitarism.Head MRI scans showed LYH like image for all the cases,and,thus,high dose methylprednisolone pulse therapy （HDMPT） was applied to the patients.Their symptoms deteriorated and the sellar mass enlarged after a short period of partial improvement.Operations were performed in all the patients.Histology study showed craniopharyngioma with abscess,primary abscess,secondary hypophysitis caused by Wegener＆#39;s granulomatosis,and germinoma with secondary hypophysitis,respectively.In conclusion,surgery or biopsy is necessary for those who presented with sellar region mass and was suspected to be with LYH,but with poor response or even worse after HDMPT.