[Panhypopituitarism as the first manifestation of sarcoidosis: case report].

Q4 Medicine
Yu A Ukhanova, I A Ilovayskaya, S A Terpigorev
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引用次数: 0

Abstract

Sarcoidosis is a systemic inflammatory disease of unknown etiology characterized by the formation of noncaseating granulomas in various organs and tissues and the activation of T-cells at the site of granulomatous inflammation with the release of various chemokines and cytokines [1]. The incidence on average ranges from 10 to 20 per 100,000 population [2]. Most often in patients with sarcoidosis, lesions of the lungs and intrathoracic lymph nodes are detected. Significantly less often (in about 5-20% of patients) damage to the nervous system is noted [6,7,9]. In 9-18% of patients with neurosarcoidosis, involvement of the pituitary gland, pituitary infundibulum and hypothalamus is found, which is manifested by a variety of clinical symptoms [8,10]. We observed a patient with sarcoidosis whose disease debuted with clinical symptoms of hypogonadism, followed by the development of signs of secondary hypothyroidism, adrenal insufficiency, and diabetes insipidus, which was initially regarded as panhypopituitarism against the background of a hypothalamic lesion of unknown origin. Later, additional examination revealed signs of intrathoracic lymphadenopathy and focal changes in the lung parenchyma on CT, as well as skin lesions. Despite the biochemical compensation of hypopituitarism, the clinical efficacy of hormonal therapy with cabergoline, testosterone, hydrocortisone and levothyroxine sodium was insufficient, and the patient's condition improved after the addition of immunosuppressive and anti-inflammatory therapy with methotrexate and methylprednisolone.

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[结节病首发表现为全垂体功能减退1例]。
结节病是一种病因不明的全身性炎症性疾病,其特点是在各器官和组织中形成非干酪化肉芽肿,肉芽肿炎症部位t细胞活化,释放多种趋化因子和细胞因子[1]。发病率平均为10 - 20 / 10万人[2]。结节病患者最常发现肺和胸内淋巴结病变。神经系统损伤的发生率明显较低(约占患者的5-20%)[6,7,9]。9-18%的神经结节病患者可累及垂体、垂体底和下丘脑,表现为多种临床症状[8,10]。我们观察到一位结节病患者,其疾病首发临床症状为性腺功能减退,随后发展为继发性甲状腺功能减退、肾上腺功能不全和尿囊症的体征,最初被认为是起因不明的下丘脑病变的全垂体功能减退症。随后,进一步检查发现胸内淋巴结病变和CT肺实质局灶性改变,以及皮肤病变。尽管垂体功能低下具有生化代偿作用,但卡麦角林、睾酮、氢化可的松、左旋甲状腺素钠等激素治疗临床疗效不足,在加用甲氨蝶呤、甲泼尼龙进行免疫抑制和抗炎治疗后,患者病情有所改善。
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来源期刊
Problemy endokrinologii
Problemy endokrinologii Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
1.40
自引率
0.00%
发文量
59
期刊介绍: Since 1955 the “Problems of Endocrinology” (or “Problemy Endocrinologii”) Journal publishes timely articles, balancing both clinical and experimental research, case reports, reviews and lectures on pressing problems of endocrinology. The Journal is aimed to the most topical issues of endocrinology: to chemical structure, biosynthesis and metabolism of hormones, the mechanism of their action at cellular and molecular level; pathogenesis and to clinic of the endocrine diseases, new methods of their diagnostics and treatment. The Journal: features original national and foreign research articles, reflecting world endocrinology development; issues thematic editions on specific areas; publishes chronicle of major international congress sessions and workshops on endocrinology, as well as state-of-the-art guidelines; is intended for scientists, endocrinologists diabetologists and specialists of allied trade, general practitioners, family physicians and pediatrics.
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