CAJ | 학술논문

目的：探讨颅内生殖细胞瘤致垂体柄增粗伴中枢性尿崩症的临床特点及诊治措施，以减少误诊误治。方法回顾性分析我院收治的1例误诊为淋巴细胞性垂体炎的颅内生殖细胞瘤致垂体柄增粗的临床资料，并复习相关文献。结果本例因多饮、多尿，伴胡须、腋毛稀疏3年，发热1周入院，曾经相关检查误诊为淋巴细胞性垂体炎导致中枢性尿崩症，给予口服糖皮质激素治疗3个月无效，后行经蝶垂体柄占位活组织病理检查确诊为生殖细胞瘤。行2次化学治疗、1次放射治疗后，瘤体明显缩小。随后给予激素替代治疗，效果良好。1周前出现上呼吸道感染，停用激素替代，进而出现垂体危象，予激素等治疗后患者病情好转出院。现病情稳定。结论颅内生殖细胞瘤致垂体柄增粗诊断除需考虑年龄、临床表现及实验室、影像学检查资料外，确诊需依据病理检查结果，以做到早诊断、早治疗，改善患者预后。
목적：탐토로내생식세포류치수체병증조반중추성뇨붕증적림상특점급진치조시，이감소오진오치。방법회고성분석아원수치적1례오진위림파세포성수체염적로내생식세포류치수체병증조적림상자료，병복습상관문헌。결과본례인다음、다뇨，반호수、액모희소3년，발열1주입원，증경상관검사오진위림파세포성수체염도치중추성뇨붕증，급여구복당피질격소치료3개월무효，후행경접수체병점위활조직병리검사학진위생식세포류。행2차화학치료、1차방사치료후，류체명현축소。수후급여격소체대치료，효과량호。1주전출현상호흡도감염，정용격소체대，진이출현수체위상，여격소등치료후환자병정호전출원。현병정은정。결론로내생식세포류치수체병증조진단제수고필년령、림상표현급실험실、영상학검사자료외，학진수의거병리검사결과，이주도조진단、조치료，개선환자예후。
Objective To investigate the clinical manifestations, methods of diagnosis and treatment of cranial germi-noma-induced pituitary stalk thickening associated with central diabetes insipid, in order to reduce misdiagnosis and mistreatment rates. Methods Clinical data of one cranial germinoma induced pituitary stalk thickening patient misdiagnosed as lymphocytic hypophysitis was retrospectively analyzed, and the related literature was reviewed. Results This patient suffered from polydipsi-a, polyuria and rarefaction of beard and hirci for 3 years, fever for 1 week, and was misdiagnosed as having lymphocytic hypoph-ysitis leading to central diabetes insipidus according to coherence check. However the symptom was not relieved after oral medi-cation of Glucocorticoids for 3 months. Then this patient was diagnosed as having cranial germinoma by endoscopic transsphenoi-dal pituitary stalk biopsy. The patient's germinoma shrank significantly and the condition was improved after 2 courses of chemo-therapy and 1 course of radiotherapy. The patient was given cortical hormone and thyroid hormones after the surgery. The patient suffered from pituitary crisis after discontinuation of cortical hormone and thyroid hormones because of upper respiratory tract in-fection one week before. The patient was in a stable condition after treatment of antibiotics and hormones. Conclusion Cranial germinoma-induced pituitary stalk thickening may be confirmed with pathology based on information such as age, clinical situa-tion, laboratory examination, imaging data for the benifit of early diagnosis, treatment, and prognosis.