出産前後のステロイド投与にて視機能が回復したリンパ球性下垂体炎の1例

A case of lymphocytic hypophysitis with improved visual function following systemic corticosteroid in the perinatal period

要約　目的：リンパ球性下垂体炎の発症が疑われた妊娠中の症例の報告。症例：29歳女性が1週間前から右眼の中心が見えにくいとの訴えで受診した。妊娠30週であった。所見と経過：矯正視力は右0.6，左1.2で，限界フリッカ値（CFF）値は右29Hz，左40Hzであった。1週間後に右眼視力は0.07に低下した。両耳側半盲があり，磁気共鳴画像検査（MRI）で下垂体腫瘤があった。リンパ球性下垂体炎が疑われた。妊娠35週で帝王切開により出産した。出産2日前からベタメタゾン12mgを筋注し，出産当日からプレドニゾロンを6日間投与した。出産5日後に右眼視力は1.0に改善し，下垂体腫瘤は縮小した。以後19か月間の経過は良好で，視野もほとんど正常化した。結論：本症例はリンパ球性下垂体炎であった可能性が高い。

Abstract.　Purpose：To report a case suspected of lymphocytic hypophysitis during pregnancy. Case：A 29-year-old female presented with blurring of central vision in the right eye since one week before. She was at 30th week of pregnancy. Findings and Clinical Course：Corrected visual acuity was 0.6 right and 1.2 left. Critical flicker frequency（CFF）was 29 Hz in the right eye and 40 Hz in the left. Visual acuity in the right eye decreased to 0.07 one week later. Bitemporal hemianopia was present. Magnetic resonance imaging（MRI）showed swelling of pituitary gland. The findings were suggestive of lymphocytic hypophysitis. She gave birth by caesarian section at 35th week of pregnancy. She received intramuscular injection of betamethasone for 2 days before parturition and prednisolone for 6 days after birth. Right visual acuity improved to 1.0 on day 5 after birth with decreased pituitary swelling. She has been doing well for 19 months until present with almost normalized visual field. Conclusion：There is a high possibility of lymphocytic hypophysitis in this patient.