The Diagnosis And Trearment Of Non-Adenomatous Pituitary Lesions (62 Cases)

Objective:To summarize the clinical features of three non-adenomatous pituitary lesions:1.Pituitary hyperplasia secondary to primary hypothyroidism;2.Rathke cleft cyst (RCC);3.Pituicytoma, and to discuss the protocol of diagnosis and principle of treatment. For the purpose of minimizing the misdiagnosis,and provide appropriate therapeutic procedure for the patients.Methods:We retrospectively analyzed the clinical data of 8 patients with pituitary hyperplasia secondary to primary hypothyroidism,52 patients with rathke cleft cyst,2 patients with pituicytoma who admitted in our hospital from May 2011 to February 2015. We analyze and compare the difference with the pituitary adenoma in clinical symptoms and endocrine manifestations and imaging features. The corresponding diagnosis and treatment methods were summarized.Results:1. Pituitary hyperplasia secondary to primary hypothyroidism and non functioning pituitary adenomas can be similar in clinical manifestations, accompanied by symptoms of hypothyroidism; The clinical manifestations of RCC and pituicytoma are abscent of distinctive features in comparison with nonfunctioning pituitary adenoma.2. In the endocrine performance, pituitary hyperplasia and pituitary adenomas are significantly different; Yet RCC and pituicytoma has no characteristic manifestations.3. In the imaging performance, compared with the pituitary adenoma, pituitary hyperplasia and RCC has significant difference; pituicytoma has no characteristic differences compared with pituitary adenoma.4.8 cases of pituitary hyperplasia were treated by supplementary therapy of thyroid hormone, in which 5 cases enlargement of the pituitary regression to normal size, and pituitary of 3 cases were significantly reduced yet not completely normal, there were no major complications, no recurrence; 52 cases of symptomatic RCCs were treated by surgery, of which 50 cases totally removed,2 cases were partly resected. Transsphenoidal approach and transfrontal approaches have no significant differences in postoperative electrolyte disturbance, hypopituitarism, seizures, vision loss complications, CSF leak and intracranial infection; 1 of 2 cases of pituicytoma was totally removed, the other partial residual, with transient diabetes insipidus.Conclusion:1. Non-adenomatous pituitary lesions including pituitary hyperplasia, pituicytoma,and rathke cleft cysts, were clinically easy to be confused with pituitary adenoma. So to prevent misdiagnosis and therapeutic error of the diseases is very important in clinical work.2. Primary hypothyroidism secondary to pituitary hyperplasia in many patients with hypothyroidism, have the features findings of MRI, T3,T4 were significantly decreased, TSH increased significantly (more than 100 uIU/ml). Supplementary therapy of thyroid hormone, in order to avoid permanent hypopituitarism caused by operation resection of pituitary hyperplasia.3. RCCs is easily confused with nonfunctioning pituitary adenoma apoplexy, special performance of the MRI is helpful for diagnosis;Surgical approaches to RCC should be considered, according to the position between the cyst and the pituitary, choose transsphenoidal or transfrontal approach surgery are selected respectively.4. Pituicytoma is lack of characteristic clinical manifestation, endocrinology manifestation, imaging manifestation, It is easyly misdiagnosed without biopsy and needs to be combined with postoperative pathological examination to confirm the diagnosis.Surgical excision of the lesion is necessary.