Pituitary metastasis from lung adenocarcinoma

Pituitary tumor is a common neuroendocrine tumor,but there are also rare clinical metastases at this site,which are generally transferred from extrabellar tumors.Although the clinical incidence is low,the prognosis is poor.The purpose of this editorial is to discuss further the relevant knowledge of pituitary metas-tases and remind clinicians to prevent missed diagnosis and improve the prog-nosis of these patients.

miR-200b-3p accelerates progression of pituitary adenomas by negatively regulating expression of RECK

MicroRNA(miR)-200b-3p has been associated with many tumors,but its involvement in pituitary adenoma is unclear.This study investigated the molecular mechanism underlying miR-200b-3p regulation in pituitary adenomas to provide a theoretical basis for treatment.Bioinformatics was used to analyze pituitary adenoma-related genes and screen new targets related to RECK and miRNA.As well,the relationship between miR-200b-3p and RECK protein was verified using a double-luciferase reporter gene assay.The expression of miR-200b-3p in clinical samples was analyzed by in situ hybridization.Transfection of the miR-200b-3p inhibitor and small interfering-RECK(si-RECK)was verified by qPCR.GH3 cell viability and proliferation were detected using CCK8 and EdU assays.Apoptosis was detected by flow cytometry and western blotting.Wound healing and Transwell assays were used to detect cell migration and invasion.The effects of miR-200b-3p and RECK on GH3 cells were verified using salvage experiments.miR-200b-3p was highly expressed in pituitary tumor tissue.Inhibitors of miR-200b-3p inhibited cell proliferation promoted cell apoptosis,inhibited invasion and migration,and inhibited the expression of matrix metalloproteinases.Interestingly,miR-200b-3p negatively regulated RECK.The expression of RECK in pituitary adenoma tissues was lower than that in neighboring tissues.Si-RECK rescued the function of miR-200b-3p inhibitors in the above cellular behaviors,and miR-200b-3p accelerated the development of pituitary adenoma by negatively regulating RECK expression.In summary,this study investigated the molecular mechanism by which miR-200b-3p regulates the progression of pituitary adenoma through the negative regulation of RECK.The findings provide a new target for the treatment of pituitary adenoma.

Pituitary metastasis from lung adenocarcinoma:A case report

BACKGROUND Pituitary gland metastasis is an unusual event,and pituitary metastasis from lung adenocarcinoma is extremely rare and associated with poor prognosis.To date,approximately 15 cases have been reported.CASE SUMMARY Here,we present the case of a 64-year-old woman with pituitary metastasis derived from lung adenocarcinoma,which was difficult to distinguish from other sellar tumors.The patient presented to the neurosurgery clinic with blurred vision and intermittent headache.During hospitalization,brain computed tomography(CT)and magnetic resonance imaging revealed a pituitary macroadenoma.Chest CT revealed irregular nodules in the basal segment of the lower lobe of the left lung,which were likely lung cancer.Positron emission tomography-CT revealed a carbohydrate metabolism tumor in the lungs and sellar region,which was considered malignant.Postoperative pathological examination of the sellar tumor revealed lung adenocarcinoma.CONCLUSION Excision of pituitary metastases combined with radiotherapy and chemotherapy should be a priority treatment for patients with pituitary metastasis.

Pituitary stalk interruption syndrome complicated with liver cirrhosis:A case report

BACKGROUND Pituitary stalk interruption syndrome(PSIS)is a rare disorder,often characterized by delayed growth and development,short stature,and hypogonadism as the main clinical manifestations.It is not clear whether PSIS can lead to liver cirrhosis.CASE SUMMARY This paper reported a case of liver cirrhosis of unknown origin.The patient was admitted to Beijing Ditan Hospital Affiliated to Capital Medical University in November 2023.The diagnosis of PSIS complicated with liver cirrhosis was established after a series of blood tests and pituitary magnetic resonance imaging examination.CONCLUSION We also reviewed the literature from both domestic and international sources to deepen the clinical understanding of PSIS in conjunction with liver cirrhosis among medical practitioners.

Pulsatile gonadotropin-releasing hormone therapy induces spermatogenesis in pituitary stalk interruption syndrome:A case report and review of the literature

BACKGROUND Pituitary stalk interruption syndrome(PSIS)is a rare anatomical defect of the pituitary gland falling under the spectrum of holoprosencephaly phenotypes.It is characterized by a deficiency in anterior pituitary hormones,such as growth hormone,gonadotropins,and thyroid hormones.Due to the syndrome's rarity and nonspecific manifestations,there is a lack of standardized treatment strategies.Consequently,early diagnosis through imaging and on-time intervention are crucial for improving patients’outcomes.CASE SUMMARY A 30-year-old man presented with absent secondary sexual characteristics and azoospermia.Laboratory evaluation revealed a deficiency in gonadotropins,while thyroid function was mostly within normal ranges.Magnetic resonance imaging of the pituitary gland showed pituitary stalk agenesis,hypoplasia of the anterior pituitary,and ectopic posterior pituitary,leading to the diagnosis of PSIS.Initially,the patient underwent 6 mo of gonadotropin therapy without significant changes in hormone levels and secondary sexual characteristics.Pulsatile gonadotropin-releasing hormone therapy was then administered,resulting in the detection of sperm in the semen analysis within 3 mo.After 6 mo,routine semen tests showed normal semen quality.The couple faced challenges in conceiving due to abstinence and underwent three cycles of artificial insemination,which was unsuccessful.They also attempted in vitro fertilization,but unfortunately,the woman experienced a miscarriage 10 wk after the embryo transfer.CONCLUSION Early detection,accurate diagnosis,and timely treatment are crucial in improving the quality of life and fertility of PSIS patients.

Clinical application of reserved gastric tube in neuroendoscopic endonasal surgery for pituitary tumor

BACKGROUND The neuroendoscopic approach has the advantages of a clear operative field,convenient tumor removal,and less damage,and is the development direction of modern neurosurgery.At present,transnasal surgery for sphenoidal pituitary tumor is widely used.But it has been found in clinical practice that some patients with this type of surgery may experience post-operative nausea and vomiting and other discomforts.AIM To explore the effect of reserved gastric tube application in the neuroendoscopic endonasal resection of pituitary tumors.METHODS A total of 60 patients who underwent pituitary adenoma resection via the endoscopic endonasal approach were selected and randomly divided into the experimental and control groups,with 30 in each group.Experimental group:After anesthesia,a gastric tube was placed through the mouth under direct vision using a visual laryngoscope,and the fluid accumulated in the oropharynx was suctioned intermittently with low negative pressure throughout the whole process after nasal disinfection,during the operation,and when the patient recovered from anesthesia.Control group:Given the routine intraoperative care,no gastric tube was left.The number of cases of nausea/vomiting/aspiration within 24 h post-operation was counted and compared between the two groups;the scores of pharyngalgia after waking up,6 h post-operation,and 24 h postoperation.The frequency of postoperative cerebrospinal fluid leakage and intracranial infection were compared.The hospitalization days of the two groups were statistically compared.RESULTS The times of postoperative nausea and vomiting in the experimental group were lower than that in the control group,and the difference in the incidence of nausea was statistically significant(P<0.05).After the patient woke up,the scores of sore throat 6 h after the operation and 24 h after operation were lower than those in the control group,and the difference was statistically significant(P<0.05).The number of cases of postoperative cerebrospinal fluid leakage and intracranial infection was higher than that of the control group,but there was no statistically significant difference from the control group(P>0.05).The hospitalization days of the experimental group was lower than that of the control group,and the difference was statistically significant(P<0.05).CONCLUSION Reserving a gastric tube in the endoscopic endonasal resection of pituitary tumors,combined with intraoperative and postoperative gastrointestinal decompression,can effectively reduce the incidence of nausea,reduce the number of vomiting and aspiration in patients,and reduce the complications of sore throat The incidence rate shortened the hospitalization days of the patients.

Simultaneous rectal neuroendocrine tumors and pituitary adenoma:A case report and review of literature

BACKGROUND Neuroendocrine tumors(NET)are rare heterogeneous tumors that arise from neuroendocrine cells throughout the body.Acromegaly,a rare and slowly progressive disorder,usually results from a growth hormone(GH)-secreting pituitary adenoma.CASE SUMMARY We herein describe a 38-year-old patient who was initially diagnosed with diabetes.During colonoscopy,two bulges were identified and subsequently removed through endoscopic submucosal dissection.Following the surgical intervention,the excised tissue samples were examined and confirmed to be grade 2 NET.^(18)F-ALF-NOTATATE positron emission tomography-computed tomography(PET/CT)and 68Ga-DOTANOC PET/CT revealed metastases in the peri-intestinal lymph nodes,prompting laparoscopic low anterior resection with total mesorectal excision.The patient later returned to the hospital because of hyperglycemia and was found to have facial changes,namely a larger nose,thicker lips,and mandibular prognathism.Laboratory tests and magnetic resonance imaging(MRI)suggested a GH-secreting pituitary adenoma.The pituitary adenoma shrunk after treatment with octreotide and was neuroendoscopically resected via a trans-sphenoidal approach.Whole-exome sequencing analysis revealed no genetic abnormalities.The patient recovered well with no evidence of recurrence during follow-up.CONCLUSION ^(18)F-ALF-NOTATE PET/CT and MRI with pathological analysis can effectively diagnose rare cases of pituitary adenomas complicated with rectal NET.

Clinical case discussions-Hypopituitarism and pituitary apoplexy caused by pituitary Adenomas

A case of“Hypopituitarism and pituitary apoplex induced by pituitary Adenomas”was collected in the Third Affiliated Hospital of Inner Mongolia medical University Geriatric Department.A rare and atypical disease as it is,delayed diagnosis and treatment is easily seen among those cases.Therefore,the paper aims to investigate the difference of clinical characteristics and treatment outcome of pituitary adenomas in elder patient through the case analysis.Clinically,patients with pituitary dysfunction may have life-threatening crisis so that timely diagnosis and aggressive treatment can be effective in reducing the pituitary crisis and reducing the misdiagnosis rate.

Morphological comparison and gonadotropins cell localization of mature female turbot and mouse pituitary

Reproduction is subtlety regulated by the hypothalamic-pituitary-gonad(HPG)axis in vertebrates.Pituitary gland is the center of the HPG axis,while pituitary gonadotropins follicle stimulating hormone(FSH)and luteinizing hormone(LH)were identified the key elements of the HPG axis in teleost and mammal.Morphology,cell lines,and gonadotropins cell localization of female turbot and mouse pituitary were determined at mature stage to illustrate the anatomical difference and cell characteristics in this study.Results show that turbot pituitary is chicken heart-shaped,dorsoventral,located on the ventral surface of the diencephalon.The mouse pituitary is oval,located in the pituitary fossa of the sella turcica at the skull base.Two well-distinguished areas adenohypophysis(AH)and neurohypophysis(NH)in pituitary were identified in turbot and mouse.Turbot AH comprised the rostral pars distalis(RPD),proximal pars distalis(PPD),and pars intermedia(PI).NH was not pronounced and with finger-like protrusions into PPD.However,mouse AH only comprised the pars distalis(PD)and PI.NH distribution was semicircular.Three main types of cells(acidophilic,basophilic,and chromophobic cells)were distributed in the mouse PD region,whereas appeared in the turbot PPD,RPD,and PI.Moreover,the percentage of mouse chromophobic and basophilic cells was higher and lower than that of turbot,respectively.The diameter of the aforementioned three cells in the mouse was significantly higher than turbot.fshβ-and lhβ-immunoreactive signals were identified in turbot-distinct pituitary cells that primarily occupied the peripheral and central regions of AH.However,mouse fsh-and lh-immunoreactive cells were expressed in the same cells and present in the PD.These results demonstrate the significantly difference of pituitary morphology,cell lines and gonadotropins(fshβand lhβ)location in female turbot and mouse.These differences help for fully understand the evolution and endocrinological functions of pituitary.

Surgical management of pituitary adenoma during pregnancy

BACKGROUND Although conservative treatment is typically recommended for pregnant patients with pituitary adenoma(PA),surgical treatment is occasionally necessary for those with acute symptoms.Currently,surgical interventions utilized among these patients is poorly studied.AIM To evaluate the surgical indications,timing,perioperative precautions and postoperative complications of PAs during pregnancy and to provide comprehensive guidance.METHODS Six patients with PAs who underwent surgical treatment during pregnancy at Peking Union Medical College Hospital between January 1990 and June 2021 were recruited for this study.Another 35 pregnant patients who were profiled in the literature were included in our analysis.RESULTS The 41 enrolled patients had acute symptoms including visual field defects,severe headaches or vision loss that required emergency pituitary surgeries.PA apoplexies were found in 23 patients.The majority of patients(55.9%)underwent surgery in the second trimester of pregnancy.A multidisciplinary team was involved in patient care from the preoperative period through the postpartum period.With the exception of 1 patient who underwent an induced abortion and 1 fetus that died due to a nuchal cord,39 patients delivered successfully.Among them,37 fetuses were healthy until the most recent follow-up.CONCLUSION PA surgery during pregnancy is effective and safe during the second and third trimesters.Pregnant patients requiring emergency PA surgery require multidisciplinary evaluation and healthcare management.

Pituitary apoplexy secondary to dengue fever-induced-thrombocytopenia:A case report and review of literature

Rationale:Pituitary apoplexy(PA)is a rare endocrine emergency that requires prompt diagnosis and management.Dengue fever-induced-thrombocytopenia may rarely predispose to PA.Patient’s Concern:A 58-year-old male patient having known pituitary macroadenoma presented to the emergency department with fever,a sudden onset severe headache,and altered sensorium.Diagnosis:Pituitary apoplexy caused by dengue fever-induced-thrombocytopenia.Interventions:Conservative management with fluids,mannitol,dexamethasone and symptomatic treatment.Outcomes:The patient responded well to the treatment and was discharged uneventfully.Lessons:Although dengue hemorrhagic fever is a rare cause of pituitary apoplexy,it should be considered if a patient presents with headache and altered sensorium,and prompt initiation of treatment is crucial to prevent fatality and neuro-ophthalmic deficits.

Cold exposure alters proteomic profiles of the hypothalamus and pituitary in female rats

Objective:Studies have shown that both short-term and long-term cold exposures disturb the biological process.The aim of the present study is to investigate the effects of intermittent cold exposure on proteomic profiles in the hypothalamus and pituitary of female Sprague-Dawley(SD)rats.Materials and methods:The rats were exposed to-10°C in a cabin for 4 h per day,and the treatment lasted for 14 days.The comparative label-free LC-MS/MS analysis was performed to investigate the changes of proteomic profiles in the hypothalamus and pituitary.ELISA analysis was used to validate the expression of differential proteins.Results:22 differential proteins in the hypothalamus and 75 differential proteins in the pituitary were identified by the label-free proteomic analysis.Gene ontology annotation and enrichment analysis indicated that cold exposure disrupted protein phosphorylation,filopodium assembly,intracellular protein transport,peripheral nervous system neuron axonogenesis,spinal cord development,Golgi organization,positive regulation of pseudopodium assembly,and cell-cell adhesion.Three proteins(Cdc42,Ptprs,and Setd7)were down-regulated in the cold exposure group.Conclusion:The results indicate that intermittent cold exposure alters the proteomic profiles of hypothalamus and pituitary in female rats.

Advances in the mechanism of action of metformin in pituitary tumors

Pituitary tumors are common intracranial tumors,but when faced with drugresistant or aggressive tumors,existing medical measures may not provide good control,leading to progression and deterioration.Metformin,a traditional hypoglycemic drug,has recently been discovered to have multiple functions including antitumor effects.There have been studies on the mechanism of metformin for the treatment of pituitary tumors,but it is uncertain whether it will provide new adjuvant or alternative therapies for the treatment of these tumors.We analyzed the potential mechanisms of action of metformin with respect to the inhibition of pituitary tumor growth and hormone secretion by reviewing the available literature.

内镜与显微镜经鼻蝶入路切除术对垂体腺瘤患者嗅觉功能、相关激素、应激反应的影响

目的 探讨内镜与显微镜经鼻蝶入路切除术在垂体腺瘤患者中的应用价值。方法 回顾性收集垂体腺瘤患者122例的临床资料,采取内镜经鼻蝶入路切除术61例,设为内镜组,采取显微镜经鼻蝶入路切除术61例,设为显微镜组。比较2组围手术期指标、相关激素[生长激素(human growth hormone,HGH)、促甲状腺素(thyrotropin,TSH)、泌乳素(prolactin,PRL)]、视觉功能[视野指数(visual field index,VFI)、视野模式标准差(pattern standard deviation,PSD)]、嗅觉功能(嗅觉识别阈)、应激反应[血管紧张素Ⅱ(angiotensinⅡ,AngⅡ)、去甲肾上腺素(norepinephrine,NE)、肾素(renin,R)]、并发症发生情况。结果 内镜组住院时间短于显微镜组,术中出血量少于显微镜组(P<0.05)。2组血清AngⅡ、NE、R水平均呈先升高再降低趋势,内镜组变化幅度小于显微镜组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组PRL、TSH、HGH水平均呈降低趋势,且内镜组低于显微镜组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组PSD呈降低趋势,嗅觉识别阈呈先升高再降低趋势,VFI呈升高趋势,内镜组PSD、嗅觉识别阈低于显微镜组,VFI高于显微镜组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05)。2组并发症发生率差异无统计学意义(P>0.05)。结论 与显微镜比较,内镜经鼻蝶入路切除术具有手术创伤小、术后恢复快等优势,有助于促进垂体功能、视觉功能恢复,降低对嗅觉功能的影响,且具有一定安全性。

Profile of Pituitary Adenomas in Senegal: Epidemiological, Clinical and Therapeutic Aspects about 241 Collected Cases

Introduction: in adults, adenomas are the most frequent causes of pituitary tumours. The objective was to characterize its epidemiological and clinical aspects, as well as its therapeutic modalities in Senegal. Methodology: this was a multicenter, retrospective, descriptive and analytical study carried out from the Senegalese register of pituitary adenomas (2008-2022). Results: 242 patients were collected with an average age of 42.4 ± 13 years and a sex ratio (M/F) of 0.91. The mean consultation time was 19.7 ± 23 months. The circumstances of discovery were pituitary apoplexy (11 cases, 4.54%), tumor syndrome (176 cases, 72.72%), gonadal manifestations (103 cases, 42.56%), dysmorphic syndrome (21 cases, 8.68%), hypercorticism (15 cases, 6.19%). Morphologically, it was a macroadenoma (197 cases, 81.40%), an extensive adenoma (22 cases, 9.10%). The hormonal profile was lactotropic hypersecretion (80 cases, 33.05%), somatotropic (13 cases, 5.39%), corticotropic (14 cases, 5.78%), mixed (9 cases, 3.71%). The factors significantly associated with prolactinoma were young age (p = 0.000), female sex (p = 0.000), long consultation delay (p = 0.000) and microadenoma (p = 0.001). Only arterial hypertension was associated with acromegaly (p = 0.000). We found a significant correlation between Cushing’s disease and microadenomas (p = 0.000). Non-secreting adenomas were significantly associated with advanced age (p = 0.000), long delay in consultation (p = 0.000), male gender (p = 0.000), tumor syndrome (p = 0.001) and macroadenomas (p = 0.000). Pituitary surgery was effective in 173 patients (71.49%) including 166 cases (68.59%) by transphenoidal approach. Postoperative incidents were transient diabetes insipidus in 82 cases (47.39%), cerebrospinal fluid leak (20 cases, 11.56%). Death was observed in 18 patients in the entire series (7.44%). The latter had a tumor syndrome (88.88%), a macroadenoma (83.33%) and had undergone pituitary surgery (72.22%). Conclusion: pituitary pathology has become a reality with clinical and secretory polymorphism. The diagnostic delay explains the predominance of macroadenomas which are sources of pre and post-operative complications.

Pituitary Adenoma Complicated by Acute Bacterial Meningitis in a Patient in Kara (Togo)

Introduction: In the context of pituitary adenoma, bacterial meningitis is a possible complication of surgical or medical treatment. The occurrence of meningitis before any treatment is exceptional, explained by the existence of an osteomeningeal breach caused by the adenoma whose main symptom is rhinorrhea. Case Report: We report a case of bacterial meningitis complicating a prolactin pituitary macroadenoma. The patient had been referred for jet vomiting in a febrile context preceded by headaches and visual blurring. There was no rhinorrhea. The examination revealed a meningeal syndrome and the diagnosis of acute bacterial meningitis was made. The isolated germ was the pneumococcus. Faced with headaches and visual blurring, a cerebral scan revealed a pituitary macroadenoma and pituitary hormone dosage had shown hyperprolactinemia. The meningitis was sterilized and the prolactinoma was treated with dopaminergic agonists. This allowed the normalization of prolactinemia and the disappearance of symptoms. Conclusion: The pituitary adenoma was complicated by bacterial meningitis without treatment and the presence of a meningeal breach. Hormonal and bacterial treatments have been successful.

Steroid-induced psychosis related to pituitary adenoma status post trans-sphenoid excision and a history of psychiatric illness:A case

BACKGROUND Steroid-induced psychosis is a common adverse effect of steroid exposure.Reported cases were mostly related to rheumatologic disease.Despite its high incidence,there is only one case reported related to perioperative steroid replacement for pituitary adenoma surgery.This manuscript presents the second case of such and compared the two with the latest literature review of steroidinduced psychosis.CASE SUMMARY This is a case of an adult male with a chief complaint of auditory hallucinations and was referred by Neurosurgery to Psychiatry Out-patient department.He was diagnosed with pituitary adenoma who underwent trans-sphenoid excision of the mass from which steroid exposure led to steroid-induced psychosis.Also,patient had a history of psychiatric illness of severe depressive episode.At the out-patient department,patient was started on antipsychotic,Risperidone,which led to eventual improvement of his symptoms.CONCLUSION The two cases of pituitary adenoma surgery with steroid-induced psychosis had almost similar clinical profile with the latest literature review of steroid-induced psychosis.However,the present case highlights the association of psychiatric illness in predisposing an individual in developing it.Also,this manuscript emphasizes that early recognition of steroid-induced psychosis leads to better prognosis.Multispecialty treatment is vital in the holistic management of the patient with timely referral and close coordination.

垂体催乳素瘤的临床特点及诊治要点更新--基于《2022版ICCE/AME垂体催乳素瘤临床实践共识》解读

垂体催乳素瘤是一种由垂体催乳素细胞瘤过量合成和分泌催乳素引起的神经内分泌疾病,垂体催乳素瘤的规范化诊疗对于恢复并维持患者的正常垂体功能并提高其生活质量具有重要意义。2022年1月,《欧洲内分泌杂志》发布了国际临床内分泌学分会(ICCE)与意大利临床内分泌学家协会(AME)关于垂体催乳素瘤的临床实践最新共识申明——《2022版ICCE/AME垂体催乳素瘤临床实践共识》(简称2022版ICCE/AME新共识)。2022版ICCE/AME新共识立足最新循证医学证据,对于垂体催乳素瘤的临床诊治问题进行系统性阐述、分析和建议。本文围绕2022版ICCE/AME新共识关于垂体催乳素瘤的诊断、治疗、特殊人群、多巴胺激动剂抵抗及侵袭性疾病等诊治要点更新进行解读,希望有助于全科医生及内分泌专科医生对于垂体催乳素瘤的认识,为其临床实践的规范化诊疗提供参考。

儿童垂体腺瘤诊断与治疗进展

垂体腺瘤为颅内良性肿瘤,常见于成人、偶见于儿童,根据是否存在激素分泌异常分为功能性和无功能性腺瘤,主要表现为内分泌功能紊乱、视觉障碍、颅内高压等。儿童垂体腺瘤发病率低,但对儿童生理和心理的影响较明显,临床诊疗具有其独特性,鉴别诊断较成人更复杂,如内分泌症状多见、副鼻窦气化不良、经鼻蝶手术对发育期儿童的影响、药物和放射治疗的儿童化及个体化、术后内分泌调节及后续生长发育等。本文对儿童垂体腺瘤近年临床研究进展进行综述,为神经外科医师诊断与治疗儿童垂体腺瘤提供参考。

加味百合地黄汤对围绝经期抑郁症模型大鼠HPO轴和雌激素受体表达的影响

目的基于下丘脑-垂体-卵巢(hypothalamic-pituitary-ovarian,HPO)轴及雌激素受体(estrogen receptor,ER)探明加味百合地黄汤治疗围绝经期抑郁症的功效及潜在机制。方法将大鼠随机分为正常对照组、模型组、阳性药物组(氟哌噻吨美利曲水溶液1.89 mg/kg)以及加味百合汤高、中、低剂量组(16.2 g/kg、8.1 g/kg、4.05 g/kg),每组10只。除正常对照组外,其他组均采用双侧卵巢摘除联合慢性不可预见性应激建立围绝经期抑郁症大鼠模型。各组给药21 d后采用糖水偏好实验和强迫游泳实验评价大鼠抑郁样行为,酶联免疫吸附法检测血清促性腺激素释放激素(gonadotropin-releasing hormone,GnRH)、卵泡刺激素(follicle-stimulating hormone,FSH)、黄体生成素(luteinizing hormone,LH)、雌二醇(estradiol,E2)含量,HE染色观察下丘脑、垂体、海马等组织病理损伤情况,RT-PCR和Western blot法检测下丘脑、海马组织雌激素受体基因及蛋白的表达。结果与正常对照组比较,模型组大鼠糖水偏好度显著下降(P<0.01),强迫游泳不动时间显著增加(P<0.01),表现出明显抑郁样行为,血清GnRH、FSH、LH含量均显著升高(P<0.01或P<0.05),E2降低(P<0.01),下丘脑、垂体及海马组织受损,雌激素受体表达显著降低(P<0.01);经加味百合地黄汤干预治疗后,模型组大鼠抑郁样行为显著改善(P<0.01或P<0.05),HPO轴亢进状态及海马损伤得以缓解,下丘脑、海马雌激素受体表达均显著增加(P<0.01或P<0.05)。与阳性药物组比较,加味百合地黄汤高剂量组下丘脑雌激素受体基因表达显著增加(P<0.05)。结论加味百合地黄汤通过抑制HPO轴亢进及增加脑内雌激素受体水平,发挥抗围绝经期抑郁症作用。