结论:使用免疫抑制药物治疗的患者,尤其是甲氨蝶呤(MTX),很少发生淋巴增生性疾病(LPDs),称为MTX相关LPD(MTX-LPD)。MTX-LPD的主要位点通常是结外的。这是垂体中MTX-LPD的首例报道。一名65岁的妇女因动眼神经麻痹和多个皮下结节的症状入院。她已经用MTX治疗了11年的类风湿性关节炎。计算机断层扫描显示轨道上有多个肿块,鼻窦,肺野,前纵隔,肾,和皮下组织.脑磁共振成像显示鞍状肿块。根据内分泌检查,她被诊断为垂体功能减退和中枢性尿崩症。虽然无法进行垂体活检,我们的结论是垂体损伤来自MTX-LPD,类似于鼻窦的病变,前纵隔,和皮下组织,活检显示多态性LPD。MTX已停产,并给予甲基强的松龙以改善神经系统症状。几周后,所有病变都有明显改善,包括垂体损伤,但是垂体功能没有改善。当垂体病变由MTX-LPD引起时,需要考虑前垂体功能减退症和中枢性尿崩症的可能性.需要进一步的研究来探讨MTX-LPD的早期诊断和治疗在恢复垂体功能障碍中的有效性。
结论:MTX-LPD的垂体病变可能导致垂体功能减退症和中枢性尿崩症。恶性淋巴瘤和原发性垂体淋巴瘤的垂体转移,与MTX-LPD具有相同的组织类型,预后不良,但是MTX-LPD的病变只有在MTX停药后才能消退。仅在垂体病变的情况下,MTX-LPD的诊断可能很困难,除非进行垂体活检.在接受免疫抑制药物治疗的患者中应考虑这种可能性。垂体功能减退和尿崩症可能持续存在,即使在由于MTX停药而使影像学上的病变消退后也是如此。
CONCLUSIONS: Patients treated with immunosuppressive drugs, especially methotrexate (MTX), rarely develop lymphoproliferative disorders (LPDs), known as MTX-related LPD (MTX-LPD). The primary site of MTX-LPD is often extranodal. This is the first reported case of MTX-LPD in the pituitary. A 65-year-old woman was admitted to our hospital with symptoms of oculomotor nerve palsy and multiple subcutaneous nodules. She had been treated with MTX for 11 years for rheumatoid arthritis. Computed tomography showed multiple masses in the orbit, sinuses, lung fields, anterior mediastinum, kidney, and subcutaneous tissue. Brain magnetic resonance imaging revealed a sellar mass. She was diagnosed with hypopituitarism and central diabetes insipidus based on endocrine examination. Although pituitary biopsy could not be performed, we concluded that the pituitary lesion was from MTX-LPD, similar to the lesions in the sinuses, anterior mediastinum, and subcutaneous tissue, which showed polymorphic LPD on biopsy. MTX was discontinued, and methylprednisolone was administered to improve the neurologic symptoms. After several weeks, there was marked improvement of all lesions, including the pituitary lesion, but the pituitary function did not improve. When pituitary lesions are caused by MTX-LPD, the possibility of anterior hypopituitarism and central diabetes insipidus needs to be considered. Further studies are needed to investigate the effectiveness of early diagnosis and treatment of MTX-LPD in restoring pituitary dysfunction.
CONCLUSIONS: Pituitary lesions from MTX-LPD may cause hypopituitarism and central diabetes insipidus. Pituitary metastasis of malignant lymphoma and primary pituitary lymphoma, which have the same tissue types with MTX-LPD, have poor prognosis, but the lesions of MTX-LPD can regress only after MTX discontinuation. In cases of pituitary lesions alone, a diagnosis of MTX-LPD may be difficult, unless pituitary biopsy is performed. This possibility should be considered in patients treated with immunosuppressive drugs. Pituitary hypofunction and diabetes insipidus may persist, even after regression of the lesions on imaging due to MTX discontinuation.