原发性空泡蝶鞍综合征致中枢性尿崩症1例报告并文献复习

Central diabetes insipidus caused by primary empty sella syndrome: a case report and literature review

  • 摘要: 目的 报道1例少见的原发性空泡蝶鞍综合征致中枢性尿崩症患者的诊断及治疗过程,并进行文献复习。 方法 患者女性,42岁,身材矮小,月经稀发,行人工周期治疗后育有1女,38岁闭经,主因“烦渴、多饮、多尿1年余”于2016年2月19日入解放军总医院。垂体MRI示空泡蝶鞍,神经垂体正常短T1信号未见显示,符合中枢性尿崩症改变。垂体功能评估结果提示腺垂体(生长激素轴、ACTH-皮质醇轴、性腺轴)及神经垂体功能均受累。诊断为原发性空泡蝶鞍综合征,垂体功能减退症,给予口服醋酸去氨加压素片治疗。 结果 患者烦渴、多饮、多尿症状明显好转出院,因无生育需求,未行性激素及生长激素替代治疗。 结论 原发性空泡蝶鞍致垂体功能减退多表现为腺垂体功能减退,但有少量患者出现神经垂体功能减退,引起中枢性尿崩症。对此类患者行全面垂体功能评估有助于及早诊断,尤其对有烦渴、多饮、多尿症状患者,需行中枢性尿崩症的筛查。

     

    Abstract: Objective To report the diagnosis and treatment of central diabetes insipidusdue caused by primary empty sella syndrome in one case, and review the related literatures. Methods A 42-year-old female patient presented with microsomia, oligomenorrhea admitted to Chinese PLA General Hospital on Feb 29, 2016. She delivered a daughter at age of 24 after artificial cycle treatment, and menopause occurred when she was 38 years of age. She complained of polydipsia and hyperdiuresis, more than 1 year on admission. Pituitary MRI showed empty sella turcica and absence of normal short T1 signal of posterior pituitary. which was consistant with the changes of central diabetes insipidus. Pituitary function test suggested that anterior pituitary (growth hormone axis, ACTH-cortisol axis, gonadal axis) and posterior pituitary function were damaged. Primary empty sella syndrome, and pituitary dysfunction were diagnosed. Results Oral desmopressin acetate treatment was effective on this patient, and symptoms including polydipsia and hyperdiuresis were relieved. No hormones or growth hormone replacement therapy was performed to this patient because of no further fertility requirement. Conclusion Hypopituitarism due to primary empty sella syndrome is generally characterized by anterior pituitary dysfunction. However, posterior pituitary dysfunction was found in some patients, causing central diabetes insipidus. Comprehensive pituitary function assessment should be made for these patients, especially for the patients with polydipsia and polyuria symptoms to avoid missed diagnosis of central diabetes insipidus.

     

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