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Pituitary Tumor Presenting as Hyponatremia: Two Case Reports
腦垂體腫瘤伴隨低血鈉症之二病例報告
摘要
本文報告二病例以低血鈉症為臨床表現徵候之腦垂體腫瘤。此二非功能性腦垂體腫瘤的診斷賴於胰島素誘發產生低血糖反應時血清可體松之濃度，及頭顱常規性愛克斯光片檢查。第一個病例，患者缺乏親腎上腺皮質素和生長激素，且以噁心、嘔吐、腹瀉並伴有低血納症為臨床表現，該病患因無法忍受開刀而拒絕外科行腦垂體腫瘤切除術，但隨後接受替代性可體松療法而使症狀改善。第二個病例，患者沒有低血鈉症的臨床表現，而是在頭部外傷接受頭顱常規性愛克斯光片檢查時，意外發現腦垂體變寬及變深，懷疑是腦垂體腫瘤。後因持續性頭痛二年，患者才接受經由蝶骨行腦垂體腫瘤切除術，並在術後接受替代性口服甲狀腺素及可體松療法，該腦垂體腫瘤在微觀下呈現厭色性腺瘤的表徵。此二病例均存有腦垂體腫瘤。腦垂體腫瘤伴隨視束交叉壓迫時，年紀較大的患者接受經由蝶骨行腦垂體腫瘤切除術，不失為一有效、可靠、耐受性極佳之于術療法。很多研究報告均指出，視力減退或視野缺損乃非功能性腦垂體腫瘤之首要徵候。然而，此二病例，在臨床上並無視力減退或視野缺損之徵候。
並列摘要
We describe two patients with pituitary tumors presenting with hyponatremia. The nonfunctioning pituitary tumors were diagnosed using insulin hypoglycemia values for plasma cortisol and routine skull radiography respectively. The first case was a patient with symptoms of nausea, vomiting and diarrhea. Investigations found hyponatremia associated with deficiencies of adrenocorticotropic hormone and growth hormone. The patient refused surgical hypophysectomy. Cortisone-replacement therapy was trialed, successfully resolving the symptoms and hyponatremia. The second patient's only symptom was persistent headache and investigations revealed hyponatremia. A routine skull radiograph after head injury following a fight had previously shown widening, deepening and enlargement of the sella turcica. He was admitted because of a two year history of headache. The symptoms resolved with thyroxine, cortisone acetate and trans-sphenoidal hypophysectomy. Microscopically, sections showed chromophobe adenoma of the pituitary gland. In conclusion, both patients had pituitary tumors. Trans-sphenoidal surgery for elderly patients with chiasmal compression is an effective and well-tolerated procedure. Visual acuity and field defects are major problems associated with non-functioning pituitary tumors reported in the literature. Interestingly, there was no impairment of visual acuity or field defect in the two patients we described.