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要約 目的:産後に視力と視野障害が発症し,非観血的治療で寛解したリンパ球性下垂体炎の症例の報告。症例:37歳の女性が子宮内感染の兆候があり,帝王切開で出産した。12日後に左眼の視力低下で受診した。所見:矯正視力は右1.2,左0.8で,両眼に非典型的な耳側半盲があった。磁気共鳴画像検査(MRI)で下垂体前葉の肥大があった。周産期の女性,乳汁分泌不全,血清プロラクチン低下などからリンパ球性下垂体炎を疑い,プレドニゾロンの経口投与を開始した。9日後に左眼矯正視力が1.5になり,12日後に視野が正常化し,MRIで下垂体腫瘤が顕著に縮小した。以後9か月後の現在まで治癒した状態にある。結論:本症例は臨床所見とステロイドの全身投与が奏効したことから,リンパ球性下垂体炎であった可能性が高い。
Abstract. Purpose:To report a presumed case of lymphocytic hypophysitis in a woman after childbirth. Case:A 37-year-old woman delivered a child by caesarean section due to suspected intrauterine infection. She noted visual disturbance in her left eye 12 days later. Findings:Her corrected visual acuity was 1.2 right and 0.8 left. Both eyes showed atypical temporal hemianopia. Magnetic resonance imaging(MRI)showed enlarged anterior lobe of pituitary body. Lymphocytic hypophysitis was suspected due to onset after childbirth, hypogalactia and low serum level of prolactin. Peroxal prednisolone at the daily dosis of 100 mg resulted in improved visual acuity after 9 days, normalization of visual field after 12 days, and decreased size of pituitary tumor by MRI. She has been doing well during 9 months until present. Conclusion:Clinical features and response to corticosteroid are highly suggestive of lymphocytic hypophysitis in this patient.
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