垂体增生临床特点及MRI表现

The Clinical Features and MRI Findings of Pituitary Hyperplasia

目的探讨不同病理生理类型垂体增生(PH)的临床特点及MRI表现。方法回顾性分析36例经临床、内分泌实验室检查及影像学共同诊断为PH的临床特点和MRI表现。结果 PH以青少年女性为主,病因主要包括生理性PH 8例(22.2%),原发性甲状腺功能减退(原发性甲减)致PH 12例(33.3%),桥本甲状腺炎继发甲减致PH 3例(8.3%),高泌乳素血症致PH 10例(27.8%),性早熟致PH 3例(8.3%)。生理性PH MRI表现为垂体均匀性膨隆,动态增强扫描均匀强化,临床多为偶然发现。原发性甲减致PH MRI表现为垂体中央膨隆及中央偏右侧结节状膨隆,呈"山丘状"或"葫芦状",边缘光滑,动态增强扫描均匀强化,临床主要表现为身材矮小。桥本甲状腺炎继发甲减致PH临床症状及MRI表现与原发性甲减致PH类似。高泌乳素血症致PH MRI表现为垂体均匀膨隆呈"球形"改变,动态增强扫描均匀强化,临床症状主要表现为泌乳及月经紊乱。性早熟致PH MRI表现为垂体结节状颗粒样增生,增强扫描有"颗粒感",临床表现第二性征出现提前、乳房增大。追踪随访4~24个月,28例患者复查MRI,其中原发性甲减致PH患者激素代替治疗后垂体大小、形态恢复到正常范围,余变化不明显。结论临床全面综合评估对PH诊疗至关重要,MRI对不同病理生理PH类型诊断及鉴别诊断、随访评估具有重要价值。

Objective To explore the MRI findings and clinical characteristics of different pathophysiological of pituitary hyperplasia(PH). Methods A retrospective analysis of the MR findings and clinical characteristics of 36 cases diagnosed as PH by clinical, laboratory examination and imaging. Results PH was dominated in young females. The main causes included 8 cases(22.2%) of physiological PH,12 cases(33.3%) caused by primary hypothyroidism, and secondary hypothyroidism in Hashimoto’s thyroiditis caused PH for 3 cases(8.3%),hyperprolactinemia caused PH for 10 cases(27.8%),and precocious puberty caused PH for 3 cases(8.3%).Physiological PH MRI showed uniform pituitary bulging, dynamic enhancement scan uniform enhancement, clinical findings were mostly accidental. Primary hypothyroidism induced PH MRI manifested as central swelling of the pituitary gland and nodular swelling on the right side of the center, “shape of hill” or “shape of calabash” with smooth edges, uniform enhancement of dynamic enhancement scans, and clinical manifestations of short stature.The clinical symptoms and MR manifestations of PH caused by secondary hypothyroidism in Hashimoto’s thyroiditis were similar to those caused by primary hypothyroidism.PH MR caused by hyperprolactinemia was characterized by uniform swelling of the pituitary gland and a “spherical” change, and the dynamic enhancement scan was uniformly enhanced. The clinical symptoms were mainly lactation and menstrual disorders. Precocious puberty caused PH MRI manifestations of pituitary nodular granular hyperplasia, enhanced scan with “graininess”,clinical manifestations of early secondary sexual signs and breast enlargement. Follow-up for 4-24 months, 28 patients were re-examined MRI. Among them, the size and shape of the pituitary gland returned to the normal range after hormone replacement therapy in the PH patients caused by primary hypothyroidism, and the others were not obvious. Conclusion Comprehensive clinical assessment is essential for PH diagnosis and treatment.MRI is of great value for the diagnosis, differential diagnosis and follow-up evaluation of different pathophysiological PH types.