原发性垂体脓肿一例及相关文献复习

Primary Pituitary Abscess: A Case Report with Review of Literature

摘要: 本文报道无明显感染症状的原发性垂体脓肿一例。患者男，74岁，自诉10年前无明显诱因出现头昏不适，间断发作，多次发作时测量血压高于正常，最高血压大于180/110 mmHg，予以硝苯地平缓释片降压治疗，症状缓解，余无不适。10天前患者无明显诱因再发头昏、伴顶枕部头部闷痛，无耳鸣、心悸、肢体麻木及活动障碍，自服硝苯地平缓释片症状无缓解，为求诊治遂来我院，门诊以“高血压病”收入心血管内科进一步诊治，入院行颅脑CT检查示鞍区占位性病变。颅脑MRI及增强检查示鞍区环形囊实性占位性病变，增强呈不规则环形强化。经院内大会诊转入神经外科行鞍区肿瘤切除手术，术中肿块切开可见黄白色脓液流出，手术及病理诊断为垂体脓肿。

Abstract: A case of primary pituitary abscess without obvious infectious symptoms is reported in this paper. A 74-year-old male patient complained that he had dizziness and discomfort without clear induce-ment since a decade ago, accompanied by intermittent attacks, and the measured blood pressure was higher than normal when he had multiple attacks, and the highest blood pressure was greater than 180/110 mmHg. He was treated with nifedipine sustained-release tablets, the symptoms were relieved, and the rest was normal. 10 days ago, without clear inducement, he suffered from dizzi-ness and stuffy pain in the head of the top and occipital part again, without tinnitus, palpitation, limb numbness and movement disorder. He took nifedipine sustained-release tablets on his own and his symptoms could not be alleviated. In order to seek further diagnosis and treatment, he came to our hospital and was admitted to the cardiovascular department for further diagnosis and treatment according to “hypertension”. Brain CT examination showed that the mass in sellar region was at the time of admission. Brain MRI and contrast-enhanced examination revealed a circular cystic solid mass in the sellar region with irregular circular enhancement. After multidisciplinary consultation in the hospital, he was transferred to neurosurgery for tumor resection in the sellar region. Yellow and white pus was seen flowing out of the mass during the operation. Finally, he was diagnosed as pituitary abscess by operation and pathology.