髄膜炎様症状後に腫瘍が縮小した先端巨大症の1例

Spontaneous Remission of Acromegaly after Meningitis :： A Case Report

要旨　症例は27歳の女性で，頭痛と発熱にて近医受診。髄液所見からウイルス性髄膜炎の診断で保存的加療を開始された。低Na血症とその顔貌から内分泌機能異常が疑われ，各種ホルモン検査を施行したところgrowth hormone（GH）とsomatomedin C（IGF-1）の高値，その他の下垂体ホルモンの低値が確認された。頭部MRIにて下垂体腺腫を指摘され精査加療目的に当院に紹介された。当院入院時のGH，IGF-1値は低下傾向で，約1カ月後の頭部MRIでも腫瘍の縮小が認められた。また，画像上で下垂体卒中とlymphocytic hypophysitisの存在が疑われた。経蝶形骨手術が施行され，病理所見にて下垂体腺腫の炎症を認めた。今回われわれは，下垂体腺腫の自然退縮の誘因としての髄膜炎様症状で発症した下垂体卒中とlymphocytic hypophysitisの関与について若干の文献的考察を加え報告した。

There have been several reports describing the cases of acromegaly, which show reduction in size of tumor in due to pituitary apoplexy or lymphocytic hypophysitis. We have encountered a patient of acromegaly, who developed panhypopituitarism after suffering from meningitis and showed the reduction of tumor in size. The results of imaging examination suggested the presence of pituitary apoplexy and lymphocytic hypophysitis.

The patient was a 27-year-old woman, who visited a local physician with complains of headache and fever. After performing lumbar puncture, she was diagnosed as viral meningitis, and conservative therapy was initiated. The results of biochemical test of blood revealed hyponatremia. Because facial appearance of the patient was similar to that of acromegaly, endocrine dysfunction was suspected. The result of pituitary hormone tests showed high levels of growth hormone（GH） and somatomedin C（IGF-1） and low levels of the other hormones. At the same time, sign of diabetes insipidus was noted, and the patient was referred to our hospital. In the examination at the admission, GH and IGF-1 showed the trends to decrease, and the reduction in size of tumor was also detected. From the results of imaging examination, pituitary aploplexy and lymphocyitc hypophysitis were suspected. Operation was performed, and pathological examination revealed inflammation of pituitary adenoma.