腺垂体功能减退的临床特征

Clinical features of anterior pituitary hypofunction

目的探讨腺垂体功能减退发病的病因、临床表现以及激素水平异常情况。方法回顾性分析福建省立医院内分泌与代谢病科2013年1月至2017年1月诊断为腺垂体功能减退的140例患者的临床资料,分析引起腺垂体功能减退的常见病因,患者的主要临床表现、实验室检查结果。结果140例患者中,垂体腺瘤患者30例(21.4%),垂体腺瘤术后28例(20.0%),颅脑放疗致垂体功能减退18例(12.9%),垂体柄阻断综合征16例(11.4%),席汉综合征15例(10.7%)等。生长激素缺乏67例(94.4%,140例中仅71例行生长激素功能检测),性腺激素缺乏114例(81.4%),甲状腺激素缺乏113例(80.7%),肾上腺皮质功能减退107例(76.4%)。临床表现:乏力(28.6%,40/140)最常见,其次为生长发育迟缓(9.3%,13/140),其他症状包括头痛(7.9%,11/140)及视觉障碍(7.1%,10/140)等。男性患者中,激素异常包括生长激素缺乏(94.6%,53/56)、性腺激素缺乏(85.0%,68/80)、甲状腺激素缺乏(81.3%,65/80)以及肾上腺皮质激素缺乏(78.8%,63/80);女性患者中,激素异常包括生长激素缺乏(93.3%,14/15)、甲状腺激素缺乏(80.0%,48/60)、性腺激素缺乏(76.7%,46/60)以及肾上腺皮质激素缺乏(73.3%,44/60)。结论导致腺垂体功能减退最常见的原因是垂体腺瘤,其次为垂体腺瘤术后;最常见的临床表现为乏力和生长发育迟缓,主要的激素异常是生长激素、性腺激素缺乏,并且不同性别患者腺垂体功能减退表现出的激素异常存在差别。

Objective To investigate the common etiology,clinical manifestations and abnormal hormone levels of anterior pituitary hypofunction (APH). MethodsA retrospective analysis was performed on 140 patients diagnosed with APH at Department of Endocrine & Metabolic Diseases,Fujian Provincial Hospital from January 2013 to January 2017. Basic clinical data were collected to analyze the common causes of APH,main clinical manifestations and laboratory examination results of the patients. ResultsAmong all 140 patients,30 (21.4%) were pituitary adenoma patients,28 (20.0%) were postoperative pituitary adenoma patients,18 (12.9%) suffered from pituitary hypofunction caused by craniocerebral radiotherapy,16 (11.4%) developed pituitary stalk interruption syndrome,and 15 (10.7%) had with Sheehan syndrome. There were 67 (94.4%) cases of growth hormone deficiency (growth hormone function measured in only 71 of 140 subjects),114 (81.4%) cases of gonadal hormone deficiency,113 (80.7%) cases of thyroid hormone deficiency and 107 (76.4%) cases of adrenocortical hypofunction. Fatigue in 40 (28.6%) cases and delayed growth in 13 (9.3%) cases were the most common complaints,headache in 11 (7.9%) and visual impairment in 10 (7.1%) were the most common symptoms. In male patients,hormonal abnormalities included growth hormone deficiency (94.6%,53/56),gonadal hormone deficiency (85.0%,68/80),thyroid hormone deficiency (81.3%,65/80),and adrenocortical hormone deficiency (78.8%,63/80). In femal patients,hormonal abnormalities included growth hormone deficiency (93.3%,14/15),thyroid hormone deficiency (80.0%,48/60),gonadal hormone deficiency (76.7%,46/60),and adrenocortical hormone deficiency (73.3%,44/60). ConclusionsThe most common reason leading to APH is pituitary adenoma,followed by pituitary adenoma after surgery. The most common complaint is fatigue. The most important hormone abnormalities are? growth hormone and gonadal hormone. There are differences in hormone abnormality caused by APH in different genders.