老年腺垂体功能减退症诊治特点

腺垂体功能减退症是腺垂体激素分泌减少所导致的临床综合征。老年腺垂体功能减退症患者的临床表现更为复杂,延误诊治可能会迅速进展为垂体危象。临床工作中需要提高对老年腺垂体功能减退的重视：低钠血症、低血糖症、不明原因昏迷患者应当进行腺垂体功能评价;已经确诊腺垂体功能减退者必须规范激素替代治疗方案,不得擅自减量或者停药。     

腺垂体功能减退症及其危象的误诊分析

腺垂体功能减退症（Simmond－Sheehan综合征）临床表现多种多样，大都系多种垂体激素缺乏所致复合症群，也有单个激素缺乏的表现。腺垂体功能减退症患者在各种应激情况下病情发生急剧变化，出现以ACTH和／或TSH缺乏为主，以代谢紊乱、意识障碍、休克为突出的一系列临床危重症群，称腺垂体功能减退危象（垂体危象），治疗不及时可引起死亡［‘j。因此，对该症及时诊断与治疗尤其重要。我院近10年来收治44例，其中7例误诊，现分析如下。临床资料一般资料腺垂体功能减退症44例（男4，女40）。年龄23～67岁（平均33．48岁）。病程4个月～23…     

Sheehan综合征出现垂体危象致死亡1例

成人腺垂体功能减退症是指各种病因损伤下丘脑、下丘脑垂体通路、垂体而引起的单一部分或全部垂体激素分泌不足而导致的疾病。现报告1例产后大出血引起的垂体坏死和垂体功能减退并垂体危象死亡患者的诊治体会。临床资料患者女性,56岁。既往有明确产后大出血病史,产后30年中眉梢、腋毛、阴毛逐渐稀疏直至脱落,40岁已无月经,20余年前出现甲状腺功能减退症,1990年在上     

线粒体糖尿病合并腺垂体功能减退症一例临床分析及文献复习

对1例合并腺垂体功能减退症的线粒体糖尿病患者的临床资料进行分析, 应用芯片捕获高通量测序对患者线粒体基因进行检测, 并对国内外相关文献进行回顾性分析。结果显示, 该患者MT-TL1基因上存在m.3243 A>G变异, 临床特征符合线粒体糖尿病及腺垂体功能减退症。     

老年垂体前叶功能减退症促性腺激素的变化及意义

目的检测老年垂体前叶功能减退症患者促性腺激素的变化,探讨促性腺激素水平在老年垂体前叶功能减退症患者的变化及诊断意义。方法对2005年6月至2010年2月解放军总医院内分泌科确诊的29例60岁以上无明确诱因首次诊断为垂体前叶功能减退症患者的临床表现、垂体相关激素指标进行回顾性分析。结果 (1)促性腺激素:黄体生成素(LH)低于正常值28例,占96.6%,卵泡刺激素(FSH)低于正常值27例,占93.1%;(2)促肾上腺皮质激素(ACTH)低于正常值27例,占93.1%;(3)促甲状腺激素(TSH)低于正常值18例,占62.1%。结论老年垂体前叶功能减退症患者促性腺激素水平降低多见,较其他垂体激素降低出现早,发生频率高,可作为老年垂体前叶功能减退症早期断的依据。     

自身免疫性垂体炎的研究进展

自身免疫性垂体炎是一种罕见的内分泌疾病，多发生于妊娠或产后。其发病机制不明，临床表现多变，主要包括垂体压迫、腺垂体功能减退症、尿崩症和高催乳素血症等相关症状。治疗目的主要是减小垂体肿块的大小和（或）替代有缺陷的内分泌功能。多数患者需要长期使用激素替代治疗。     

内分泌系统疾病

20051091 腺垂体功能减退症昏迷15例治疗体会/赵保明…//中原医刊.-2004,31(3).-7～8 对15例患者给予静滴10％葡萄糖注射液,氢化可的松针100mg,Q6h,同时给予左旋甲状腺素片100μg,Qd。并给予吸氧化、抗休克、抗感染及支持疗法。结果:治愈12例,死亡3例。低血糖是腺垂体功能减退症昏迷最根本的原因。肾上腺皮质机能衰竭及继发的甲状腺机能减退具有同等的重要性。参1(曾怡佳)     

13N-NH3、18F-FDG PET显像在对心肌存活状况评估中的临床应用

目的探讨^13N-氨水(^13N-NH3)、^18F-脱氧葡萄糖(^18F-FDG)正电子断层显像(PET)心肌血流／代谢显像在陈旧性心肌梗死患者心肌存活状况评估中的临床应用价值。方法陈旧性心肌梗死患者20例，均采用^13N-NH3、^18F-FDG PET心肌灌注／代谢显像预测存活心肌。灌注缺损、代谢填充(血流-代谢不匹配)为心肌存活；灌注、代谢均缺损(血流-代谢匹配)为心肌无存活；同时进行超声心动图检查评价左室壁运动。PTCA 支架术后3—6个月，进行超声心动图检查随访评价左室壁运动的改善情况，其中12例患者在术后进行了^13N-NH3、^18F-FDG PET显像随访。结果PET显像判定为存活的心肌，介入治疗后87．5％的心肌节段运动功能得到改善；而判定为无存活的心肌节段介入治疗后，仅有2．4％的心肌节段运动功能得到改善。12例中，术后^13N-NH3、^18F-FDG PET、结果证实，存活心肌介入治疗后85．7％的心肌节段血流灌注及代谢恢复正常，而治疗前判定为无存活的心肌节段仅有3．3％的心肌节段血流灌注及代谢恢复正常。结论^13N-NH3、^18F-FDG PET显像对于心肌存活的估价及预测和(或)评价冠状动脉血管重建的疗效具有重要的临床应用价值。     

腺垂体功能减退症18例误诊原因分析

2007年1月～2008年8月,我院内分泌科收治腺垂体功能减退症患者34例,其中初诊时门诊误诊18例.现将其误诊原因分析如下.     

垂体危象的诊治总结与回顾

<正>本文对垂体危象的历史、流行病学、病因、临床特点、诊断要点、治疗措施等各个方面进行了回顾性和经验性的总结,特别是对产后垂体缺血性坏死和垂体瘤出血性卒中引起的危象临床处理有一定的指导和借鉴作用。垂体危象是在原有垂体功能减退症基础上,因腺垂体部分或多种激素分泌不足,在遭遇应激后,或因严重功能减退自发地发生的休克、昏迷和代谢紊     

18F-FDG PET/CT显像判断乳腺癌复发及转移的价值

目的探讨^18F-FDG PET/CT显像判断乳腺癌复发和转移的临床价值.方法28例手术治疗后临床疑有肿瘤复发或转移的乳腺癌患者均进行^18F-FDG PET/CT全身显像,应用目测法和半定量分析法判断结果（标准摄取值,SUV）.结果病理、活检、细胞学检查等证实17例有局部复发和（或）转移,^18F-FDG PET/CT显像正确诊断16例,检测灵敏度、特异性（94.12%,90.91%）明显高于传统影像学方法;在62个肿瘤复发和（或）转移灶中,PET/CT及常规影像学检查检出率分别为91.94%（57/62）、72.58%（45/62）,P＜0.05.结论^18F-FDG PET/CT显像是早期诊断乳腺癌复发和（或）转移良好的、无创性方法.     

18F-FDG PET/CT显像在进展期前列腺癌诊断和分期中的应用

目的探讨^18F-FDG PET/CT显像在进展期前列腺癌诊断和分期中的临床价值.方法20例临床进展期前列腺癌患者行^18F-FDG PET/CT全身显像,同时行B超和骨扫描检查.结果①9例未经治疗者中^18F-FDG PET/CT确诊8例;全雄激素阻断治疗（MAB）后前列腺特异性抗原（PSA）值较稳定者及逐渐升高者共5例,PET/CT均准确显示;6例MAB反应良好者,^18F-FDG PET/CT示其病灶均无放射性浓聚（即阴性）.②6例盆腔淋巴结转移和6例骨转移者中^18F-FDG PET/CT分别发现5例和4例,假阴性者均为MAB后反应良好患者.结论^18F-FDG PET/CT显像是评估进展期前列腺癌激素治疗效果的无创性检查方法,有利于未治疗、激素治疗有部分反应及激素难治性进展期前列腺癌的诊断和临床分期.     

Positron emission tomography--usefulness in assessing myocardial viability.

Positron emission tomography (PET) using N-13 ammonia and F-18 fluorodeoxyglucose (FDG) has been used to evaluate myocardial viability in comparison with thallium-201 single photon emission computed tomography (SPECT), and left ventricular wall motion in comparison with contrast ventriculography. Forty patients with anterior myocardial infarction underwent stress and delayed resting perfusion imaging using Tl-201 SPECT and ammonia PET, a glucose metabolism study using FDG PET, and wall motion assessment with left ventriculography. Out of a total of 600 segments of left ventricular imaging, SPECT demonstrated 197 fixed perfusion defects, 99 with redistribution on delayed imaging and 304 normal segments. Of 197 segments with fixed defects, 24 (12%) were normal and 71 (36%) ischemic according to PET criteria. Nineteen of 28 with infarction and all of 12 with non-Q wave infarction showed a viable myocardium. Left ventricular wall motion was significantly better in patients with normal PET findings compared with those with ischemia or scar on PET. Post-PTCA PET revealed improved ammonia PET in 6 of 11 patients but reduced FDG uptake was noted only in 3. These data suggests that Tl-201 SPECT significantly underestimates myocardial viability and that PET imaging is a promising tool for assessing the presence of salvaged myocardium.     

No difference in cardiac event-free survival between positron emission tomography-guided and single-photon emission computed tomography-guided patient management: a prospective, randomized comparison of patients with suspicion of jeopardized myocardium

OBJECTIVES: We sought to prospectively compare nitrogen-13 (13N)-ammonia/18fluorodeoxyglucose (18FDG) positron emission tomography (PET)-guided management with stress/rest technetium-99m (99mTc)-sestamibi single-photon emission computed tomography (SPECT)-guided management. BACKGROUND: Patients with evidence of jeopardized (i.e., ischemic or viable) myocardium may benefit from revascularization, whereas patients without it should be treated with drugs. Both PET and SPECT imaging have been proven to delineate jeopardized myocardium. When patient management is based on identification of jeopardized myocardium, it is unknown which technique is most accurate for long-term prognosis. METHODS: In a clinical setting, 103 patients considered for revascularization with left ventricular wall motion abnormalities and suspicion of jeopardized myocardium underwent both PET and SPECT imaging. The imaging results were used in a randomized fashion to determine management (percutaneous transluminal coronary angioplasty [PTCA], coronary artery bypass graft surgery [CABG] or drug treatment). Follow-up for cardiac events (cardiac death, myocardial infarction and revascularization) was recorded for 28 +/- 1 months. The study was designed to have a power of 80% to detect a 20% difference in the event rate between PET- and SPECT-based management. RESULTS: Management decisions in 49 patients randomized to PET (12 who had PTCA, 14 CABG and 23 drug therapy) were comparable with 54 patients randomized to SPECT (15 who had PTCA, 13 CABG and 26 drug therapy). In terms of cardiac event-free survival, no differences between PET and SPECT were observed (11 vs. 13 cardiac events for PET and SPECT, respectively; p = NS by the Kaplan-Meier statistic). CONCLUSIONS : No difference in patient management or cardiac event-free survival was demonstrated between management based on 13N-ammonia/18FDG PET and that based on stress/rest 99mTc-sestamibi SPECT imaging. Both techniques may be used for management of patients considered for revascularization with suspicion of jeopardized myocardium.     

Role of radionuclide imaging for diagnosis of device and prosthetic valve infections

Cardiovascular implantable electronic device(CIED) infection and prosthetic valve endocarditis(PVE) remain a diagnostic challenge.Cardiac imaging plays an important role in the diagnosis and management of patients with CIED infection or PVE.Over the past few years,cardiac radionuclide imaging has gained a key role in the diagnosis of these patients,and in assessing the need for surgery,mainly in the most difficult cases.Both ~(18)F-fluorodeoxyglucose positron emission tomography/computed tomography(~(18)F-FDG PET/CT) and radiolabelled white blood cell single-photon emission computed tomography/computed tomography(WBC SPECT/CT) have been studied in these situations.In their 2015 guidelines for the management of infective endocarditis,the European Society of Cardiology incorporated cardiac nuclear imaging as part of their diagnostic algorithm for PVE,but not CIED infection since the data were judged insufficient at the moment.This article reviews the actual knowledge and recent studies on the use of ~(18)F-FDG PET/CT and WBC SPECT/CT in the context of CIED infection and PVE,and describes the technical aspects of cardiac radionuclide imaging.It also discusses their accepted and potential indications for the diagnosis and management of CIED infection and PVE,the limitations of these tests,and potential areas of future research.     

Clinically non-functioning pituitary macroadenomas in the elderly

BACKGROUND AND AIMS: The aim of the present study was to evaluate the clinical presentation, characteristics and post-surgical outcome of non-functioning pituitary macroadenomas (NFPM) in elderly patients. METHODS: 27 patients (65-81 years; 13 Males, 14 Females) with NFPM (20-45 mm in diameter) were studied. The symptoms prompting neuroradiological studies were vision alterations in 52%, and dizziness, loss of memory, confusion, headache and depression in 29%; in 19% of patients, the disease was incidentally discovered during computed tomography (CT) or magnetic resonance imaging (MRI) for head trauma or cerebral ischemic attacks. RESULTS: Endocrinological evaluation on diagnosis showed global anterior hypopituitarism in 33% and partial hypopituitarism in 37% of patients. Immunohistochemistry showed signs of neurosecretion in most NFPM (chromogranin-A in 55%, gonadotropins in 19%, ACTH in 3.7%). Ki-67 antigen expression was indicative of low proliferative activity. Surgery was highly effective in improving alterations in vision and compressive symptoms, but was unable to restore normal pituitary function in established hypopituitarism in most cases. Eight patients (31%) were free of disease on subsequent MRI (follow-up 1-6 years). In 18 (69%) patients, a post-surgical residue was present. Of these, 6 (33%) underwent radiotherapy in the following years, owing to an increase in the volume of the remnants, and six (33%) underwent additional surgical treatment, followed by radiotherapy for further signs of growth in two. In the remaining patients, a small intrasellar remnant was stable on yearly MRI. CONCLUSIONS: in elderly patients, the development of hypopituitarism is often overlooked and the initial diagnosis of NFPM may be delayed. This can expose patients to the risks of unrecognized hypopituitarism and jeopardize post-surgical outcome.     

Role of N-13 ammonia PET/CT in diagnosing pancreatic necrosis in patients with acute pancreatitis as compared to contrast enhanced CT – Results of a pilot study

BackgroundContrast enhanced computerized tomography (CECT) is used to determine severity of acute pancreatitis based upon the presence and extent of necrosis. However limitations do exist precluding its applicability in renal failure. Positron emission tomography (PET) imaging for cardiac perfusion shows good uptake of N-13 ammonia (¹³NH₃) metabolites in pancreas owing to high perfusion.AimTo evaluate the role of ¹³NH₃ PET/CT in acute pancreatitis and compare it with CECT in diagnosing and quantifying pancreatic necrosis.Material and methodsPatients presenting within 1 week of acute pancreatitis were studied. Static PET images were acquired after intravenous injection of 370–740 MBq of ¹³NH₃. ¹³NH₃ PET/CT was followed by CECT in the absence of renal impairment. Maximum standard-uptake-value (SUVmax) of pancreas (P) and liver (L) were taken and their ratio (P/L) was estimated to determine perfusion. Areas within pancreas with no tracer uptake were considered necrotic. These patients were managed as per institutional protocol. Patients undergoing ¹³NH₃ PET/CT for coronary artery disease were used as controls.Results29 patients (72% males) were studied of whom 6 had elevated serum creatinine. ¹³NH₃ PET/CT was done in all patients along with 9 controls while CECT was carried out after PET/CT in 23 patients. Median levels of SUVmax (P/L) in the controls, uninvolved pancreas and necrotic areas were 1.0 (0.86–1.03), 0.66 (0.50–0.92) and 0.12 (0.07–0.21) respectively (p < 0.001). Necrosis estimation was similar in 22/23 patients without renal failure while in one patient only ¹³NH₃ PET/CT picked up necrosis (<30%). 5/6 patients with renal failure had necrosis on ¹³NH³ PET/CT which was confirmed on surgery or subsequent CECT after improvement of renal failure.ConclusionThis pilot study is the first in literature to diagnose necrosis in patients with acute pancreatitis using ¹³NH₃ PET/CT. With minimal additional radiation burden, it is possible to estimate the absolute tissue perfusion as well. With no adverse renal side effects, this can be an alternative to CECT in patients with renal failure giving similar information. It has good agreement with CECT with a good interobserver acceptability.     

PET-CT显像在直肠癌术后局部复发诊断中的价值

目的评价^18F-脱氧葡萄糖（FDG）PET—CT定性及半定量显像技术在直肠癌术后局部复发诊断中的临床价值。方法对20例临床可疑直肠癌术后局部复发的患者行全身^18F—FDGPET—CT显像，将显像结果与病理组织学及临床随访结果对比。结果病理组织学及临床随访证实，局部复发15例。采用定性方法诊断直肠癌术后局部复发的灵敏性和特异性分别为100％、60％。采用半定量法显示恶性肿瘤的标准摄取值（SUV，范围为2．7～17．2，平均9．9）明显高于良性病变者（SUV为1．3～4．0，平均2．6），诊断直肠癌术后局部复发的灵敏性和特异性分别为100％、80％。结论全身^18F—FDGPET-CT显像有利于直肠癌术后局部复发的定性及定位诊断；半定量方法较定性法更具有特异性。     

All patients with ‘idiopathic’ hypopituitarism should be screened for hemochromatosis

Hypopituitarism usually occurs as the result of a pituitary tumour or as a consequence of its treatment. If, however, pituitary imaging is negative then an alternative diagnosis should be sought. Patients are often diagnosed as having idiopathic hypopituitarism when imaging is normal. Our objective is to highlight the importance of screening for hemochromatosis in patients with presumed ‘idiopathic’ hypopituitarism. Our patients presented initially with biochemical hypopituitarism and, after initial investigation and normal imaging, were labelled as having idiopathic disease. They subsequently developed iron overload in cardiac and hepatic tissue respectively requiring regular venesection to deplete body stores. Genetic analysis revealed homozygosity for the C282Y mutation in our first patient thus explaining his more severe iron overload whereas our second case was a heterozygote for the same mutation, with iron overload confirmed on liver biopsy. We recommend that iron studies are performed in all patients who present with hypopituitarism and normal pituitary imaging. This may lead to reversal of the hypopituitarism and avoid development of any systemic consequences of hemochromatosis.