COPD并原发性空泡蝶鞍综合征致腺垂体功能减退症1例并文献复习

Chronic obstructive pulmonary disease and pituitary deficiency caused by primary empty sella syndrome:a case report and literature review

目的探讨空泡蝶鞍综合征致腺垂体功能减退症的临床特点、发病机制、诊断和治疗措施。方法报道1例COPD并空泡蝶鞍综合征致腺垂体功能减退症患者的临床资料,并对历年文献进行分析。结果经头颅MRI提示为部分空泡蝶鞍,内分泌激素测定为腺垂体功能减退,诊断为COPD合并原发性空泡蝶鞍综合征致腺垂体功能减退症,在规范治疗COPD的基础上,联合激素替代治疗,患者咳喘、纳差乏力等临床症状改善。结论空泡蝶鞍的发生和发展可能与妊娠有关。COPD致低氧血症和高碳酸血症的病理生理学特征,可能是形成空泡蝶鞍的重要因素和环节。腺垂体功能减退症临床表现复杂多变,与COPD的临床症状相似或叠加,易出现漏诊和误诊的差错,需全面评估腺垂体功能,对已确诊的病例必须规范予激素替代治疗,切勿擅自减量或停药。

Objective To investigate the clinical features,pathogenesis,diagnosis and treatment of pituitary deficiency caused by empty sella syndrome.Methods The clinical data of a patient with COPD and pituitary deficiency caused by empty sella syndrome were reported,and the literature of the past years were analyzed.Results The head MRI indicated partial empty sella,and the endocrine hormone was determined as pituitary deficiency,which was diagnosed as COPD and pituitary deficiency caused by primary empty sella syndrome.On the basis of the standard treatment of COPD,combined with hormone replacement therapy,the clinical symptoms of the patient were improved,such as cough and asthma,poor appetite and so on.Conclusion The occurrence and development of cavitation sella sella may be related to pregnancy.The pathophysiological features of hypoxia and hypercapnia caused by COPD may be an important factor and link in the formation of empty sella.The clinical manifestations of pituitary deficiency were complex and variable,which were similar to or superimposed with the clinical symptoms of COPD.As a result,misdiagnosis and missed diagnosis were easy to occur.Therefore,it was necessary to comprehensively evaluate the functions of the adenohypophysis.Hormone replacement therapy must be standardized for diagnosed cases,and it was not allowed to reduce or stop taking medicine.