視力低下をきたしたうつ病小児に発見された下垂体腫瘍

Visual impairment as the initial manifestation of pituitary tumor in a child with depression

要約　目的：視力障害を契機として下垂体腫瘍が発見されたうつ病男児の報告。症例：17歳男児が視力低下で受診した。7か月前から登校拒否になり，うつと診断された。所見：矯正視力は右0.5，左1.5で，前眼部，中間透光体，眼底，眼球運動に異常はなく，対座法とAmslerチャートで視野異常はなかった。視力低下の原因として，うつによる集中力の低下を疑った。初診から3週間後に右眼視力が零になり，左眼に耳側半盲が生じた。CT検査でトルコ鞍部に最大径26mmの腫瘍が発見され，血液検査などから胚細胞腫と診断した。さらに問診で，多飲，多尿，口渇感，全身倦怠感などが5年前からあったことが判明し，尿崩症，副腎機能低下，甲状腺機能低下が推定された。化学療法と放射線照射で腫瘍は縮小した。視力は4か月後に右1.0，左1.5に改善し，うつ状態も消失した。結論：うつ病によると推測される視力障害が，頭蓋内腫瘍によって起こることがある。

Abstract.　Purpose：To report a case with impaired visual acuity which appeared initially due to depression and which finally proved to be due to pituitary tumor. Case：A 17-year-old high-school student presented with impaired visual acuity. He had refused to attend school since 7 months before and had been diagnosed with depression. Findings：His corrected visual acuity was 0.5 right and 1.5 left. Routine ophthalmological examinations showed normal findings. Visual acuity in the right eye decreased to no light perception 3 weeks later. The left eye showed temporal hemianopia. Computed tomography showed a tumor with 26 mm as maximal diameter in the sella turcica. Systemic studies were suggestive of germ cell tumor. Upon further enquiry,he had had polyuria,polydipsia and generalized fatigue since 5 years before. These symptoms as well as depression disappeared after chemotherapy and radiation. The pituitary tumor decreased in size. Visual acuity improved to 1.0 right and 1.5 left after 4 months of treatment. Conclusion：This case illustrates that depression with impaired visual acuity may be manifestations of intracranial tumor.