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題 名 | Hypothalamus-Pituitary Infundibular Mass Lesion Manifesting with Hypopituitarism and Diabetes Insipidus--A Case Report=下視丘-腦垂體莖腫瘤併發垂體機能不足及尿崩症--一病例報告 |
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作 者 | 許上人; 廖培湧; 杜思德; | 書刊名 | 內科學誌 |
卷 期 | 13:6 2002.12[民91.12] |
頁 次 | 頁300-307 |
分類號 | 415.663 |
關鍵詞 | 腦垂體機能不足; 尿崩症; 腦垂體莖; Pituitary infundibular lesion; Hypopituitarism; Diabetes insipidus; |
語 文 | 英文(English) |
中文摘要 | 病患為五十歲男性肝硬化病人患有性功能喪失五年。理學檢查發現生殖腺功能低下之徵狀包括陰毛、腋毛缺乏及面貌女性化。亦發現有低血壓、低血鈉及嗜伊紅血球偏高。初步內分泌學檢驗顯示血液FSH,LH,testosterone及DHEA-S均測不到而prolactin上升。早晨codisol及甲狀腺素血液濃度皆偏低。腦垂體機能不足隨後以GnRH刺激試驗及胰島素低血糖試驗証實。病患於是給予甲狀腺素、皮質醇及睪固酮補充治療。然而在給予皮質醇後病人尿量大量增加。因而以限水測試及desmopressin反應診斷為中樞尿崩症。磁振攝影顯示一8 x 3 x 9mm腫瘤位於腦垂體莖,為病患之內分泌機能異常病因。病患選擇以荷爾蒙補充保守治療。然而一年後追蹤磁振攝影顯示垂體莖腫瘤明顯擴大為2 x l x l cm並侵入下視丘及後腦垂體。垂體莖腫瘤尚未有病理診斷。鑑別診斷包含肉芽腫疾病、滲入性疾病、感染、血管病變、及原發或轉移性腫瘤。腦垂體機能不足同時合併尿崩症較可能源自下視丘-腦垂體部位之病灶。局限於前腦垂體之病灶甚少併發尿崩症。垂體莖病灶之起因涵蓋惡性及良性、局部及系統性疾病;鑑別診斷均須考量。 |
英文摘要 | A 50-year-old Taiwanese man with cirrhosis of the liver had a 5 year history of sexual dysfunction and was noted to have apparent signs of hypogonadism including absence of pubic and axillary hair and feminine facial features. Hypotension, hyponatremia, and eosinophilia were also found. Initial endocrinologic studies revealed undetectable serum levels of FSH, LH, testosterone, and DHEA-S but elevated prolactin level. Morning cortisol and free thyroxine serum levels were both below normal limits. Hypopituitarism was confirmed subsequently with GnRH stimulation test and insulin hypoglycemic test. Patient was given thyroxine and corticosteroid replacement and testosterone injections as treatment for panhypopituitarism. However, an abrupt increase in urine output developed soon after the administration of glucocorticoid. Neurogenic diabetes insipidus ( DI) was then diagnosed via water deprivation and stimulation with desmopressin. The cause of the endocrinologic abnormalities was attributed to a 8 x 3 x 9 mm mass lesion within the pituitary infundibulum as the MRI revealed. Patient opted for a period of conservative therapy with hormone replacement. However, follow-up MRI of the pituitary a year later showed enlargement of the infundibular mass to 2x 1 x 1 cm, with involvement of the hypothalamus as well as the posterior pituitary. The nature of the mass lesion is still unknown. Differential diagnoses include granulomatous, infiltrative, infectious, vascular, and primary or metastatic tumoral diseases. Coexistence of hypopituitarism and diabetes insipidus signifies possible involvement of hypothalamic-pituitary region. Isolated anterior pituitary diseases rarely cause DI. Pituitary stalk abnormalities may have malignant and non-malignant, and localized as well as systemic causes. All must be considered in the differential diagnosis |
本系統中英文摘要資訊取自各篇刊載內容。