Neurological Surgery 脳神経外科33巻10号

2005年10月発行

症例

下垂体腺腫に極めて類似したMRI像を呈したリンパ球性下垂体炎の1症例

著者： 山口秀¹ 加藤功¹ 竹田誠¹ 安齋治一² 池田仁³

所属機関： ¹函館中央病院脳神経外科 ²函館中央病院内科 ³函館中央病院病理検査科

ページ範囲：P.971 - P.977

Ⅰ．はじめに

　リンパ球性下垂体炎は，下垂体組織にリンパ球が浸潤し腫瘤を形成する疾患で，MRI上，しばしば下垂体腺腫との鑑別が非常に困難である^{1,3,10,11,13,16,22,27)}．今回われわれは，妊娠後期に視野障害で発症し，MRIにて非機能性下垂体腺腫と術前診断したリンパ球性下垂体炎の1例を経験した．本症例を提示し，本疾患を念頭に置くべき状況や治療方針について考察を加えたので報告する．

参考文献

1）Bellastella A, Bizzarro A, Coronella C, Bellastella G, Sinisi AA, De Bellis A：Lymphocytic hypophysitis：A rare or underestimated disease? Eur J Endocrinol 149：363-376, 2003

2）Beressi N, Cohen R, Beressi JP, Dumas JL, Legrand M, Iba-Zizen MT：Pseudotumoral lymphocytic hypophysitis successfully treated by corticosteroid alone：first case report. Modigliani E. Neurosurgery 35：505-508; discussion 508, 1994

3）Beressi N, Beressi JP, Cohen R, Modigliani E：Lymphocytic hypophysitis. A review of 145 cases. Ann Med Interne (Paris) 150：327-341, 1999

4）Biswas M, Thackare H, Jones MK, Bowen-Simpkins P：Lymphocytic hypophysitis and headache in pregnancy. BJOG 109：1184-1186, 2002

5）Bottazzo GF, Pouplard A, Florin-Christensen A, Doniach D：Autoantibodies to prolactin-secreting cells of human pituitary. Lancet 2：97-101, 1975

6）Crock P, Salvi M, Miller A, Wall J, Guyda H：Detection of anti-pituitary autoantibodies by immunoblotting. J Immunol Methods 162：31-40, 1993

7）Crock PA：Cytosolic autoantigens in lymphocytic hypophysitis. J Clin Endocrinol Metab 83：609-618, 1998

8）Goudie RB, Pinkerton PH：Anterior hypophysitis and Hashimoto's disease in a young woman. J Pathol Bacteriol 83：584-585, 1962

9）Guay AT, Agnello V, Tronic BC, Gresham DG, Freidberg SR：Lymphocytic hypophysitis in a man. J Clin Endocrinol Metab 64：631-634, 1987

10）Hartmann I, Tallen G, Graf KJ, Unterberg A, Lanksch WR, Stoltenburg-Didinger G：Lymphocytic hypophysitis simulating a pituitary adenoma in a nonpregnant woman. Clin Neuropathol 15：234-239, 1996

11）Honegger J, Fahlbusch R, Bornemann A, Hensen J, Buchfelder M, Muller M, Nomikos P：Lymphocytic and granulomatous hypophysitis：experience with nine cases. Neurosurgery 40：713-22; discussion 722-723, 1997

12）Kristof RA, Van Roost D, Klingmuller D, Springer W, Schramm J：Lymphocytic hypophysitis：non-invasive diagnosis and treatment by high dose methylprednisolone pulse therapy? J Neurol Neurosurg Psychiatry 67：398-402, 1999

13）Leung GK, Lopes MB, Thorner MO, Vance ML, Laws ER Jr：Primary hypophysitis：a single-center experience in 16 cases. J Neurosurg 101：262-271, 2004

14）Matta MP, Kany M, Delisle MB, Lagarrigue J, Caron PH：A relapsing remitting lymphocytic hypophysitis. Pituitary 5：37-44, 2002

15）宮城航一，新垣辰也，伊藤壱裕，古閑　比佐志，銘刈晋，金城利彦，新垣有正，仲宗根　進：新疾患概念としてのlymphocytic infundibulo-hypophysitis with diabetes insipidusの提唱：症例報告と文献的考察．No Shinkei Geka 25：169-175, 1997

16）McGrail KM, Beyerl BD, Black PM, Klibanski A, Zervas NT：Lymphocytic adenohypophysitis of pregnancy with complete recovery. Neurosurgery 20：791-793, 1987

17）Muir A, Maclaren NK：Autoimmune diseases of the adrenal glands, parathyroid glands, gonads, and hypothalamic-pituitary axis. Endocrinol Metab Clin North Am 20：619-644, 1991

18）Ng WH, Gonzales M, Kaye AH：Lymphocytic hypophysitis. J Clin Neurosci 10：409-413, 2003

19）Nishiki M, Murakami Y, Ozawa Y, Kato Y：Serum antibodies to human pituitary membrane antigens in patients with autoimmune lymphocytic hypophysitis and infundibuloneurohypophysitis. Clin Endocrinol (Oxf) 54：327-333, 2001

20）Nishioka H, Ito H, Miki T, Akada K：A case of lymphocytic hypophysitis with massive fibrosis and the role of surgical intervention. Surg Neurol 42：74-78, 1994

21）Nishioka H, Ito H, Fukushima C：Recurrent lymphocytic hypophysitis：case report. Neurosurgery 41：684-686, 1997

22）荻野満春，三橋洋一，貝原　学：妊娠後期より産褥期にかけて視力・視野障害を呈したlymphocytic hypophysitisの一例．日産婦誌：1701-1704, 1991

23）Pouplard A, Bottazzo GF, Doniach D, Roitt IM：Binding of human immunoglobulins to pituitary ACTH cells. Nature 13; 261：142-144, 1976

24）Reusch JE, Kleinschmidt-DeMasters BK, Lillehei KO, Rappe D, Gutierrez-Hartmann A：Preoperative diagnosis of lymphocytic hypophysitis (adenohypophysitis) unresponsive to short course dexamethasone：Case report. Neurosurgery 30：268-272, 1992

25）Scherbaum WA, Schrell U, Gluck M, Fahlbusch R, Pfeiffer EF：Autoantibodies to pituitary corticotropin-producing cells：Possible marker for unfavourable outcome after pituitary microsurgery for Cushing's disease. Lancet 20；1 (8547)：1394-1398, 1987

26）Selch MT, DeSalles AA, Kelly DF, Frighetto L, Vinters HV, Cabatan-Awang C, Wallace RE, Solberg TD：Stereotactic radiotherapy for the treatment of lymphocytic hypophysitis. Report of two cases. J Neurosurg 99：591-596, 2003

27）Skandarajah A, Ng WH, Gonzales M, Kaye AH：Lymphocytic hypophysitis mimicking pituitary macroadenoma. J Clin Neurosci 9：586-589, 2002

28）Takao T, Nanamiya W, Matsumoto R, Asaba K, Okabayashi T, Hashimoto K：Antipituitary antibodies in patients with lymphocytic hypophysitis. Horm Res 55：288-292, 2001

29）Yamagami K, Yoshioka K, Sakai H, Fukumoto M, Yamakita T, Hosoi M, Ishii T, Sato T, Tanaka S, Fujii S：Treatment of lymphocytic hypophysitis by high-dose methylprednisolone pulse therapy. Intern Med 42：168-173, 2003