摘要：

目的 结合文献对4例垂体脓肿患者的发病原因、临床表现、影像学和内分泌功能特点、治疗方法及预后进行回顾总结。方法与结果 2015年1月至2019年8月共治疗534例鞍区病变患者，其中4例为垂体脓肿，约占0.89%，原发性3例、继发性1例；临床表现为头痛、视物模糊和颞侧偏盲、乏力纳差等腺垂体功能减退症状，伴多饮多尿（2例）或短暂性发热（2例）；MRI可见鞍区囊性占位性病变，囊壁呈典型均匀强化（4例）；内分泌功能测定提示甲状腺功能减退症（4例）、肾上腺皮质功能减退症（3例）和性腺功能减退症（3例）。术前经对症激素替代和头孢曲松抗感染治疗后，行神经内镜下经蝶窦入路垂体脓肿清除术；术后垂体功能恢复正常3例、遗留肾上腺皮质功能减退症1例（需终身激素替代治疗），随访3个月无复发迹象。结论 垂体脓肿早期可出现垂体功能减退症状，MRI以边缘强化囊性占位效应为特征；外科治疗推荐神经内镜下经蝶窦入路垂体脓肿清除术，患者多预后良好，复发率较低。

关键词: 脑脓肿, 垂体, 蝶窦, 神经外科手术, 预后

Abstract:

Objective To report 4 patients with pituitary abscess (PA), and summarize etiology, clinical manifestation, imaging, endocrinological characteristics, treatment and prognosis of PA in combination with literatures review. Methods and Results Four patients (3 cases were primary PA, one case was secondary PA) from January 2015 to August 2019 were included in the study during 534 cases whose sellar region lesion were diagnosed. The main clinical manifestations were headache (4 cases), blurred vision and temporal blindness (4 cases), fatigue and anorexia (4 cases), polyuria (2 cases) and transient hyperthermia (2 cases). MRI showed cystic occupying lesions in the sellar region, with typical enhancement in the cystic wall (4 cases). Endocrinology showed hypothyroidism (4 cases), hypoadrenocorticism (3 cases) and hypogonadism (3 cases). After hormone replacement therapy (HRT) and antibiotic anti-infection treatment, endoscopic transsphenoidal removal of PA was adopted. The clinical symptoms gradually improved. Pituitary function in 3 cases returned to normal, one case still needed HRT. MRI showed no sign of recurrence of PA. Conclusions Early symptoms in PA is prone to hypopituitarism. PA is characterized by edge-enhanced cystic space-occupying lesion in MRI. Endoscopic transsphenoidal removal of PA is the fine-line treatment and the prognosis is good while the patients' recurrence rate is low.

Key words: Brain abscess, Pituitary gland, Sphenoid sinus, Neurosurgical procedures, Prognosis