以情绪低落为主诉的中年男性Rathke裂隙囊肿1例报道及文献复习

Rathke’s cleft cyst in a middle-aged man with chief complaint of depression : A case report and literature review

目的:报道1例以情绪低落为主诉的中年男性Rathke裂隙囊肿并对相关文献进行复习。方法:1例就诊于华中科技大学同济医学院附属同济医院的男性患者,年龄51岁,因"情绪低落4年"首诊于神经内科门诊,患者自述4年前因生意不顺,压力大,出现严重的情绪低落。查体正常,汉密尔顿抑郁量表评分为19分,实验室检查甲状腺功能正常,诊断为"抑郁症"。给予抗抑郁药物治疗,但效果不佳,遂至同济医院生殖男科就诊,仔细询问病史,发现同时存在性功能障碍和射精后无精液。查生殖激素全套,提示卵泡刺激素(FSH)0.88IU/L,促黄体生成素(LH)0.25 IU/L,泌乳素30.8 nmol/L,睾酮(T)<0.24 nmol/L,空腹血糖3.9 nmol/L,考虑为低促性性腺功能低下症。进一步查垂体MRI,提示Rathke裂隙囊肿,促肾上腺皮质激素和生长激素水平正常。由此可以诊断:1. Rathke裂隙囊肿;2.继发性性腺功能低下症;3.抑郁;4.继发性无精液症。随后,建议患者至神经外科进一步做治疗。结果:2018年在导航及内镜辅助下经鼻蝶鞍区Rathke裂隙囊肿显微切除术,术后病理提示为:镜下见纤维结缔组织囊壁内衬假复层纤毛柱状上皮,伴慢性炎症性细胞浸润,考虑为垂体Rathke裂隙囊肿。术后3个月,患者复查生殖激素,T 0.72 nmol/L,给予雄激素替代治疗后3个月复查睾酮10.3 nmol/L,患者情绪、性欲及性功能有明显改善,射精后有少量精液射出。结论:Rathke裂隙囊肿是引起中老年男性性腺功能低下的可能原因之一,主要是囊肿通过压迫垂体,导致促性腺激素缺乏,引起临床症状。对于情绪低落伴有性腺功能低下症状的患者,经过手术切除后,促性腺激素也很难恢复,仍然需要术后雄激素替代治疗。

Objective: To present a case of Rathke’s cleft cyst(RCC) in a middle-aged man complaining of depression and review the relevant literature. Methods: A 51-year-old man firstly visited the outpatient clinic of neurology in our hospital due to 4 years of low mood. The patient was found normal in physical and thyroid function laboratory examinations and achieved a total score of 19 in Hamilton Depression Scale, which indicated depression. After failure to respond to antidepressant medication, the patient again came to the clinic of andrology and was found with sexual dysfunction and aspermia. With the serum FSH, LH, PRL, T and fasting blood glucose levels of 0.88 IU/L, 0.25 IU/L, 30.8 nmol/L, <0.24 nmol/L and 3.9 nmol/L respectively, it was considered to be a case of hypogonadotropic hypogonadism. Pituitary MRI indicated RCC but the adreno-cortico-tropic hormone and growth hormone were normal. All the data obtained led to the final diagnosis of RCC, acquired hypogonadotropic hypogonadism, depression and acquired aspermia and therefore the patient was referred to the department of neurosurgery and underwent navigation-and endoscopy-guided microsurgical resection of the Rathke cleft cyst via the nasopharynx and sella region in 2018. Results: RCC was pathologically confirmed postoperatively. At 3 months after surgery, the patient was found with a serum T level of 0.72 nmol/L and received the testosterone replacement therapy. After 3 months of treatment, the serum T was increased to 10.3 nmol/L, the patient’s symptoms of depression, hyposexuality and sexual dysfunction were significantly improved, and a little semen was observed in the ejaculate. Conclusion: RCC is one of causes of hypogonadism in middle-aged men, causing the clinical symptoms mainly by pressing the pituitary gland and inducing gonadotropin deficiency. It is hard for RCC patients with depression and sexual dysfunction to restore gonadotropin to normal even after surgical removal of the cyst and therefore testosterone replacement therapy is necessitated postoperatively.