假性垂体瘤英文及病例.ppt

1、English Case report,Diagnosis and Therapy of Pituitary pseudotumor (pituitary thyrotroph hyperplasia) Neurosurgery Department,English Case report,Nowadays more and more lesions in saddle area are found by CT and MRI especially pituitary adenoma. Do you think all lesions in saddle area can be diagnos

2、ised pituitary adenoma,English Case report,Many patients diagnosised pituitary adenoma preoperation was demonstrated to be hyperplasia or Pituitary pseudotumor ,but not tumor. So, what led us to the misdiagnosis,English Case report,What is so-called “Pituitary pseudotumor” or “ pituitary hyperplasia

3、”,English Case report,Pituitary gland,Thyriod gland, suprarenal gland, ovarian,hypothalamus,The axis of hormone control in our body,Control function,Reverse feedback,English Case report,That is to say “the shape and function of pituitary is controlled by hypothalamus and feedback-affected by target

4、organs such as Thyriod gland suprarenal gland ovarian,English Case report,The way that made these control goes is based on the hormone, such as TSH, ACTH, PRL, FSH, LH, GH T3T4, virosterone, cortisol, E2,English Case report,Case 1 famale, 15years, complained “delayed growth ,acratia and a blur eyesi

5、ght for 5 months”. Hormone tests showed decreased T3T4 level mardkedly high TSH level(75mIU/L,English Case report,A,B,C,D,picture A-C demonstrate a larger pitutary gland,which grow upward like a ball with a clear boundary. The optic nerve and chiasm were raised.Theres no difference between lesion an

6、d posthypophysis. Picture D shows a delayed growth of the bone in wrist(about 5-6years compared to normal children,English Case report,Now, do you still keep the diagnosis of pitutary adenoma in your mind? Why are the lesion not enhanced? How do you think about the thyriod hormone and TSH level,Engl

7、ish Case report,Indeed, there are something strange in this case which can not be eaplained by pitutary adenoma. After the therapy of levothyroxine for 3 month, the complaint disappeared and nothing was found in MRI scan,English Case report,So, its pituitary pseudotumor. What is so-called “pituitary

8、 pseudotumor or pituitary hyperplasia”,physiological,pathological,adolescent pregnancy lactation,Decreased function of the target gland the hormone therapy of great does Tumors that secrete hormone,English Case report,The most likely cause of pituitary pseudotumor is decreased function of the target

9、 gland especially thyriod gland. These patients usually come for cure with the syndrome of acratia,edema,delayed growth. Sometimes with damage of eyesight,English Case report,The less likely cause of pituitary pseudotumor is decreased function of the target gland of ovarian and suprarenal gland with

10、 the syndrome of lactation, advanced menstruation and puberfy,English Case report,The most important thing is precise dignosis and hormone therpy. Levothyroxine is usually accomdated, if needed, GH can be given at the same time. The Hormone level should be checked usually,English Case report,The MRI scan should be made after 3 months therapy. If the lesion decreased,we call it pituitary pseudotumor and take the way