| BACKGROUDWith the development of medical technology and the growing popularity of MRI use in recent years, the incidence, diagnosis and treatment of pituitary disease rate is rapidly increased. In response to the growing health needs and a better service to patients, it is necessary for us to have a better understanding of pituitary disease. Pituitary lesions constitute a large class of diseases of Endocrinology and metabolism, but it is still uncommon compared to other common endocrine and metabolic diseases (such as diabetes, hyperthyroidism); Because pituitary unique anatomical location, adjacent to the structure importance, hormone secretion is complex, Pituitary lesions are generally knotty in clinic. And for pituitary disease which involves many disciplines at the same time, including the Endocrinology, Neurology, Neurosurgery, Nuclear Medicine and Radiology Department, interdisciplinary understanding of disease and focus is different, so the diagnosis and treatment of some pituitary disease are still controversial; the corresponding guides are still maturing. Therefore, knowing of pituitary disease composition, proportion, disease changes and relevant data can help us seizing the key, optimizing the allocation of scarce medical resources, and further improving the awareness of the rare diseases.Lesions of the pituitary or hypothalamus and adjacent tissue can affect the endocrine function of pituitary. when most part of the pituitary is damaged, can lead to a lack of pituitary hormones, and thus produce the performance of endocrine dysfunction, called hypopituitarism in clinic. There are many causes lead to Pituitary dysfunction. Pituitary lesions (such as tumors, Sheehan’s syndrome) can reduce the secretion of pituitary hormones; hypothalamic lesions or the connection between hypothalamic-pituitary interrupts (such as pituitary stalk interruption syndrome), make the hypothalamic hormone cannot reach to the pituitary, and lead to pituitary dysfunction. The most common reasons that lead to pituitary dysfunction in adults are pituitary tumor, pituitary surgery or radiotherapy; in remote region with poor health condition, pituitary ischemic necrosis caused by postpartum hemorrhage is a important and common reason for pituitary dysfunction. In addition, the damage of pituitary normal anatomy (such as empty sella) can also affect pituitary function.Sheehan’s syndrome and pituitary stalk blocking syndrome both can affect pituitary function, so the clinical manifestations should have similarities in theory. While observation in the clinical work is:the manifestations of pituitary dysfunction in sheehan’s syndrome often appears in the order of gonad axis, thyroid axis and adrenal cortex axis, usually marge electrolyte imbalance, and pituitary crisis prone to certain incentive. While the most common manifestation of pituitary interruption syndrome is growth hormone deficiency, followed by gonad axis hormone deficiency symptoms; thyroid axis hormones deficiency can be found in some patients, and a severe lack is rare. Fewer patients had adrenal cortex axis hormone deficiencies. So far there is no studies at home or abroad about the comparison between two diseases.Empty sella syndrome is a disease relatively rare in clinical, and for its special lesion location, the clinical manifestations is complex. With the wide application of MRI, the disease showed increasing trend. But there is little clinical data of ESS, and lack of large-scale clinical studies and epidemiological investigations. Awareness of the disease is still not enough.This study is based on the present status and problems mentioned above, and analyzed175cases of Hypopituitarism in our hospital between January2001and December2012. We focused on three diseases (sheehan’s syndrome, pituitary stalk interruption syndrome, empty sella syndrome) which can impair the pituitary function, analyzed the data about disease characteristics, clinical manifestations, hormone levels, and reviewed some literature, hoped a further understanding of these diseases. This research is divided into the following three parts:Prat1:Investigation on the Cause of175Cases of HypopituitarismObjectiveThrough the investigation of175cases of Hypopituitarism to know the cause and proportion of them.MethodsA total of175patients with Hypopituitarism between January2001to December2012were collected, the data of number, sequence, proportion were retrospective analyzed.Results1.There are85(48.57%) male patients and90(51.43%) female patients, the average age was33.22±21.78and41.11±18.15years respectively. Onset time in male is relatively younger than female, the difference was statistically significant(P<0.05).2.126cases had clear causes, while the rest49cases had no clear causes.3.126cases that had clear causes include48cases of Sheehan’s Syndrome,40 cases of Intracranial Surgery,15cases of Pituitary Stalk Interruption Syndrome,7cases of pituitary tumor,5cases of Kallmann’s Syndrome,5cases of Hypopituitarism after cranial radiotherapy,4cases of Postpartum autoimmune pituitary gland inflammation, and2cases of Frohlich Syndrome. There were49cases of other cases of Hypopituitarism. The main remote causes include viral encephalitis, phthisis, serious infection, serious malnutrition, autoimmune disease and so on.Conclusion1.The leading cause of Hypopituitarism in this group is Sheehan’s Syndrome with a total of48cases.2.Pituitary Tumor is the second cause of Hypopituitarism in this group, include7cases of tumor,36cases after pituitary tumor operative treatment and4cases after pituitary tumor radiotherapy.3.Pituitary Stalk Interruption Syndrome is the third cause of Hypopituitarism in this group, with a total of15cases. Prat2:Clinical Characteristics of Sheehan’s Syndrome in48Patients and Pituitary Stalk Interruption Syndrome in15Patients:A Comparative AnalysisObjectiveBy comparing the past medical history, clinical manifestations, hormone and biochemical level of48cases of Sheehan’s syndrome and15cases of pituitary stalk interruption syndrome to have a better understanding of the similarities differences of these two kinds of disease.MethodsA retrospective analysis on the data of48cases Sheehan’s syndrome and15cases pituitary stalk interruption syndrome, which were collected from the inpatients in GuangDong general hospital from2001January to2012December and2009January to2012December respectively. Compared the similarities and differences between these two diseases, include the previous medical history, clinical manifestations, biochemical and hormone levels.Results1.48cases of Sheehan’s syndrome patients were all female, with a mean age of43.77±14.48years old; there were13male and2female inl5cases of pituitary stalk interruption syndrome patients, with an average age of18.55±6.60years old. There are significant differences in the average age of the two groups (P<0.05).2.48Sheehan’s syndrome patients all had postpartum hemorrhage history, with an average of13.01±11.40years after the perinatal events to final diagnosis. The most common symptoms were amenorrhea, hair shedding and other gonadal damage symptoms, followed by fatigue, fatigue, chills and other symptoms of thyroid axis decline.3.5cases of pituitary stalk interruption syndrome had perinatal events;14patients with growth retardation or sex developmental delays, the main symptoms including genitalia naive, lack of secondary sexual characteristics and no erection, emission or menstrual cramps;12patients had bone age retardation diagnosed by X-ray;3patients had hypophrenia.4.Laboratory examination data of Sheehan’s syndrome:37cases detected the gonadal hormone, of which26cases (70.27%,26/37) appeared dysfunction;43cases detected thyroid axis hormones, and31cases (70.09%,31/43) were functional decline; 35cases detected adrenal cortical hormone, of which25cases (71.43%,25/35) appeared dysfunction;20patients detected growth hormone, and10cases (50%,10/20) were below0.03ng/ml;45patients detected biochemical indicators, a total of26cases (57.78%,26/45) had electrolyte disorder in different degree,14people (31.11%,14/45) appeared disorder of lipid metabolism.5.Pituitary stalk interruption syndrome:.All cases hadcomplete assessment of pituitary hormone levels, in which13cases (86.67%,13/15) had gonadal dysfunction,11cases (73.33%,11/15) had thyroid dysfunction,12cases (80%,12/15) had adrenal cortex axis dysfunction,13cases (86.67%,13/15) had growth hormone deficiency,2cases (13.33%,2/15) had hyperprolactinaemia;1cases (6.67%,1/15) with a hypokalemia;10cases (66.67%,10/15) with dyslipidemia.6. Comparison of hormone axis dysfunction and biochemical disorder:The incidence of growth hormone deficiency in PSIS patients were higher than in SS patients(PSIS:86.67%vs SS:50.00%, P=0.024); the two groups of patients with gonadal axis dysfunction were SS:70.27%, PSIS:86.67%, incidence of thyroid dysfunction were SS:70.09%, PSIS:73.33%, incidence of adrenal axis dysfunction were SS:71.43%, PSIS:80.00%, there were no significant difference (P>0.05) between each group. Electrolyte disturbance occurred in SS patients was significantly higher than that of PSIS patients, the difference was statistically significant (SS:57.78%vs, PSIS:6.67%, P=0.001). Occurrence of dyslipidemia in patients with PSIS was significantly higher than that of SS patients, the difference was statistically significant (PSIS:66.67%vs, SS:31.11%, P=0.015).7.Comparison of hormone and biochemical level:Average level TSH in patients with SS was significantly lower of PSIS patients, the difference was statistically significant (SS:1.37±1.26μIU/ml vs PSIS:4.42±3.08μIU/ml, P=0.002); while average level of FSH, LH in patients with PSIS were significantly lower in patients with SS, the difference had statistical significance (PSIS:0.96±0.62IU/L vs SS:5.13±3.92IU/L, P<0.001; PSIS:0.43±043IU/L vs SS:2.55±2.56IU/L, P<0.001); the average levels of electrolyte in patients with SS were:Na+:134.73±8.49mmol/L, Cl-:100.69±7.68mmol/L, K+:3.60±0.50mmol/L, Ca2+:2.17±0.15mmol/L, and in PSIS patients were:Na+:138.23±2.39mmol/L, Cl-:105.10±3.03mmol/L, K+:3.91±0.53mmol/L, Ca2+:2.33±0.11mmol/L; each index in two groups had significant difference, the average levels of SS patients were lower than PSIS patients(P<0.05). Average level of total cholesterol in SS patients were higher than that in PSIS patients, the difference was statistically significant (SS:5.29±1.67mmol/L vs PSIS:4.16±2.11mmol/L,P=0.039)Conclusion1.SS and PSIS are different in causes and the onset population, both of which can affect the pituitary gland function.2.Clinical feature of hypopituitarism in sheehan’s syndrome appears follow the order of gonadal axis, thyroid, adrenal cortisol axis dysfunction. The most common symptoms were amenorrhea, hair shedding and other gonadal damage symptoms, followed by fatigue, fatigue, chills and other symptoms of thyroid axis decline.3.Pituitary stalk interruption syndrome mainly has a lack of growth hormone, gonadal axis function decline, and is prone to growth retardation and sex developmental retardation; thyroid and adrenal cortisol axis function serious decline relatively rare.4.a higher incidence of electrolyte imbalance in sheehan’s syndrome than that in pituitary stalk interruption syndrome, and the incidence in the latter is rare.5.Both sheehan’s syndrome and pituitary stalk interruption syndrome can cause dyslipidemia; this set of data shows that patients with pituitary stalk interruption syndrome have higher rates of dyslipidemia. Prat3:Investigation on Clinical characteristic of inpatient with empty-sella syndromeObjectiveTo summarize the causes, risks and the clinical manifestations of empty-sella syndrome(ES S).Methods48cases of ESS with relative complete clinical data were collected from January20001to December2012and were retrospectively analyzed.Results1.A total of48cases,17were males and31were females with a mean age of (51.7±21.9) years and (46.5±17.1) years respectively.2.39patients were diagnosed as primary empty sella(PES), while other9were diagnosed as secondary empty sella(SES), with a mean age of46.4±18years and48.8±19.3years old respectively.3.There were26female PES patients and20(76.9%,20/26) of which had pregnancy history, with a mean age of51.8±15.6years old;11cases(42.3%,11/26) were multiparous, the mean age of which was56.9±13.8years old;6cases had no pregnancy history, with a mean age of27.0±10.1years old.4.16patients (33.3%) had headache symptoms, the most common symptom in this group;9patients(18.75%) had visual impairment;3female patients and1male patient had hyperprolactinemia;3stunting of growthadmission of patients with growth hormone secretion;3patients were diagnosed as diabetes insipidus which were confirmed by water deprivation vasopressin test.5.29patients were detected the sex hormones(FSH, LH, E2, PRL, progesterone, testosterone), and2cases were found hypogonadism(6.9%,2/29);44patients were tested TSH, FT3and FT4,15patients were found thyroid dysfunction (34.1%,15/44);39patients were detected early morning8:00ACTH and cortisol, and4cases was found adrenal insufficiency (10.3%,4/39).6.25cases of patients who were detected the three-axis hormone levels:6cases (24%,6/25) had simple thyroid axis diminished;2cases (8%,2/25) had simple adrenal axis insufficiency; thyroid axis combined gonadal axis decreased was found in1cases(4%,1/25); three-axis simultaneous decline was also found in1cases (4%,1/25); a total of10cases of pituitary dysfunction (40%,10/25). Analyzed by cause, there were18cases of primary empty sella and7cases of secondary empty sella; pituitary dysfunction incidence was(38.9%,7/18) and (42.9%,3/7) respectively, and had no significant difference (P>0.05); analyzed by the degree of empty sella, there were9cases of completely empty sella and16cases of partial empty sella, pituitary dysfunction incidence was (33.3%,3/9) and (43.8%,7/16) respectively, the incidence had no significant difference (P>0.05).Conclusions1.The incidence of PES is relative higher in middle-aged females especially those who were multiparous.2.Pregnancy is an incentive of Primary empty sella, so the prevalence of female is relative higher than male.3.Headache is one of the most common symptoms of empty sella,33.3%patients had this symptom in this group, and was less than the data(60-80%) that reported in the literature.4.SES is more likely to be associated with visual disturbances than PES; while there is no obvious difference between their effect to pituitary function.5.Data of this group shows that35.4%of the patients had various degrees of hypopituitarism, and the rate of thyroid dysfunction is relatively higher (34.1%,15/44).6.Out data the incidence of hypopituitarism had no obvious differences between both primary and secondary empty sella, complete an partial empty sella, suggest that patients with ESS should test the relevant hormones regularly. |
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