自身免疫性垂体炎：COVID-19 大流行期间的病例观察

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垂体炎是一种罕见的炎症性疾病，其特征是垂体及其柄的受累。该病可能由垂体组织浸润、自身免疫因素、感染性疾病或其他未明原因引起。由于某些垂体肿瘤（如垂体腺瘤和转移瘤）可能具有相似的临床特征，因此该病的临床诊断具有挑战性。磁共振成像是诊断疑似垂体炎以及鉴别腺垂体炎（前叶受累）与漏斗-神经垂体炎（垂体柄和后叶受累）的主要方法。垂体炎可分为原发性（自身免疫性）和继发性。继发性垂体炎可能继发于局灶性病变 （如肉芽肿、囊肿或腺瘤）或系统性疾病（如结节病、肉芽肿性多血管炎）。其临床表现受多种因素影响，其中之一是基础治疗。临床病例已有相关文献报道。

本文报道了一例 37 岁女性患者的临床病例，该患者既往诊断为高泌乳素血症，并接受卡麦角林对症治疗。患者被转诊进行磁共振成像检查，结果显示垂体信号不均匀。2021年7月随访磁共振成像显示垂体信号不均且增大。2021年12月，患者感染COVID-19并发生重度肺炎，接受糖皮质激素治疗及氧疗。2022年5月磁共振成像检查显示垂体明显增大且信号不均。在使用泼尼松（晨 10 mg，晚 5 mg）治疗后，患者的临床及影像学表现显著改善。

患者随访至COVID-19 大流行结束。对于此类患者，影像学结果的解读和治疗方案的选择可能受到新冠病毒感染及其治疗的影响。

在评估垂体炎的病程及其影像学变化时，医生应考虑 COVID-19 相关治疗，尤其是糖皮质激素对疾病的影响。

作者简介

Evgeniy N. Surovcev

Samara State Medical University; Diagnostic and treatment center of International institution for biological systems named after Sergey Berezin

Email: evgeniisurovcev@mail.ru
ORCID iD: 0000-0002-8236-833X
SPIN 代码: 5252-5661

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Samara; Tolyatti

Pavel M. Zelter

Samara State Medical University; Meir Hospital

Email: pzelter@mail.ru
ORCID iD: 0000-0003-1346-5942
SPIN 代码: 3678-3932

MD, Cand. Sci. (Medicine)

俄罗斯联邦, Samara; Kfar-Sava, Israel

Aleksandr V. Kapishnikov

Samara State Medical University

Email: a.kapishnikov@gmail.com
ORCID iD: 0000-0002-6858-372X
SPIN 代码: 6213-7455

MD, Dr. Sci. (Medicine), Professor

俄罗斯联邦, Samara

Yuliya S. Pyshkina

Samara State Medical University

编辑信件的主要联系方式.
Email: yu.pyshkina@yandex.ru
ORCID iD: 0000-0002-7241-6828
SPIN 代码: 4225-1020

MD, Cand. Sci. (Medicine), Assistant Professor

俄罗斯联邦, Samara

参考

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  7. Karrou M, Benyakhlef S, Alla A, et al. Clinical presentation and management of hypophysitis: an observational study of case series. Surg Neurol Int. 2021;12:304. doi: 10.25259/sni_454_2021 EDN: ZYMRCD
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2. Fig. 1. MRI of the pituitary gland that was obtained on May 2, 2020. a) sagittal T1-weighted image, b) coronal T2-weighted image, and с) contrast-enhanced sagittal T1-weighted image. The size of the pituitary gland (*) was normal and slightly heterogeneous.

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3. Fig. 2. MRI of the pituitary gland that was obtained on July 9, 2021. а) sagittal T1-weighted image, b) coronal T2-weighted image, and с) contrast-enhanced sagittal T1-weighted image. Note. There is a moderate increase in the size of the pituitary gland, an increase in the signal intensity in the pituitary gland substance in the T2-weighted images (*), and heterogeneous enhancement in the central region of the gland.

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4. Fig. 3. MRI of the pituitary gland that was obtained on February 4, 2022. а) sagittal T1-weighted image, b) coronal T2-weighted image, and c) contrast-enhanced sagittal T1-weighted image. Note. Progression of the lesion is noted. Thickening of the chiasm (arrows) and infundibulum and increase in the size and structure of the pituitary gland were noted without pronounced dynamics when compared with the imaging study obtained on July 9, 2021.

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5. Fig. 4. MRI of the pituitary gland that was obtained on May 2, 2022. a) sagittal T1-weighted image, b) coronal T2-weighted image, and c) contrast-enhanced sagittal T1-weighted image. The dimensions of the pituitary gland are markedly enlarged (mainly due to the suprasellar component), its structure is heterogeneous, and its contours are uneven. The chiasm is compressed. There is a pronounced uneven thickening of the mucous membrane of the sphenoid sinus, exhibiting increased signal intensity on the T2-weighted image (*).

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6. Fig. 5. MRI of the pituitary gland that was obtained on October 3, 2022. а) sagittal T1-weighted image, b) coronal T2-weighted image, and c) contrast-enhanced sagittal T1-weighted image. The pituitary gland is not enlarged with heterogeneous contrast enhancement in the central regions. The chiasm is thickened, and its structure is moderately heterogeneous. These changes are positive in comparison with the findings of the previous MRI.

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7. Fig. 6. Contrast-enhanced T1-weighted coronal MR images of the pituitary gland obtained on a) May 2, 2020, b) July 9, 2021, c) February 4, 2022, d) May 2, 2022, and e) October 3, 2022. Over 1.5 years, the MRI findings pertaining to the pituitary gland in a patient with autoimmune hypophysitis evolved. First a, then an abrupt The size and heterogeneity of the pituitary gland increased, with the appearance of a non-contrasting area, probably due to necrosis (*). This increase was gradual at first (within 21 months: May 2, 2020 to February 4, 2022) and subsequently rapid (within three months: May 2, 2022 to October 3, 2022). The changes completely disappeared within 5 months after the administration of glucocorticosteroids.

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