垂体脓肿的诊断、治疗和长期随访

目的垂体脓肿是一种少见的鞍区感染性疾病，其临床表现没有特异性，术前诊断比较困难。为了更好地发现其临床特点以助于临床诊断，为了评估垂体脓肿手术治疗的疗效及其长期转归，我们分析总结了我院手术治疗的垂体脓肿病例资料。方法回顾性分析总结北京协和医院1991年～2007年17年间手术证实和治疗的30例垂体脓肿病例，对所有病例的详细病史资料、术前术后的影像学资料和内分泌检查结果及长期随访资料均进行了仔细分析和总结。结果垂体脓肿患者往往因为垂体占位性病变的相关症状而就诊，很少表现为感染相关的症状。中枢性尿崩、垂体功能低下、头痛是最常见的临床症状；MRI表现多样，但多数具有脓肿的典型表现即鞍区囊性占位，静脉注射对比剂后可见病灶边缘环形强化；尽管术后复发并不少见，大多数垂体脓肿通过手术引流可以治愈，但垂体功能低下往往很难恢复，需要长期激素替代治疗。结论临床上表现为尿崩、垂体功能低下伴有环形强化的鞍区占位往往提示垂体脓肿的诊断；治疗上首选经蝶脓肿引流手术，尽管伴有一定的复发率，手术往往可以治愈脓肿，但垂体功能低下往往不能恢复，需要重视长期替代治疗。

Diagnosis, management and longtime follow-up of pituitary abscess

Objective Pituitary abscess is a rarely infectious disease in sellar region and its presen- ting manifestations are non--specific, so the correct diagnosis is still difficult. To better determine the salient signs and symptoms of pituitary abscess that may help us making the correct diagnosis, and to evaluate the effect of the surgical therapy on this disease, we made a review on patients with pituitary abscess surgically treated at Peking Union Medical College Hospital （PUMCH）. Methods A total of 30 patients with pituitary abscess enrolled at PUMCH between 1991 and 2007 were included in this retrospective study. All of them underwent surgery and followed antibiotic therapy. In all patients the detailed signs and symptoms, and the complete history were obtained; pituitary imaging and endocrinal functions were examined. Results Most patients presented with complaints and physical findings consistent with a sellar mass, but rarely with infection--related symptoms. Diabetes insipidus, hypopituitarism, and headache were generally the most common clinical indicators. MR imaging demonstrated the typical features of sellar cystic mass with thicken rim enhanced after gadolinium injection. Even with several recurrences, the abscess dismissed in almost all cases by means of surgical drainage. Hypopituita- rism, however, was generally difficult to recover, thus the longtime hormone replacement therapy was needed in this case. Conclusions Diabetes insipidus, hypopituitarism, and sellar cystic mass with thicken rim enhanced may be suggestive of the diagnosis {or pituitary abscess. Transsphenoidal evacuation and followed antibiotic therapy are recommended for most patients with pituitary abscess; the abscess could usually be cured, but hypopituitarism was difficult to recover and required lifelong hormonal replacement.