摘要
目的探讨空蝶鞍(ES)患儿垂体激素的改变及激素替代治疗(HRT)的剂量。方法测定1999年9月～2006年3月以生长迟缓就诊的20例ES患儿(经下丘脑-垂体MRI确诊)垂体激素,并与年龄匹配的正常对照组进行比较;同时观察HRT的合适剂量。结果20例中18例有难产史,所有患儿均伴有多种垂体激素缺乏症(MPHD):ES患儿FT4和F显著低于对照组,其中12例>10岁的男性患儿FSH、LH、T均显著低于对照组(P<0.001),E2和PRL均显著高于对照组,6例禁水加压素试验和MRI检查证实为垂体性尿崩症。相应HRT剂量:重组人生长激素为(0.11±0.01)U/(kg.d),左旋甲状腺素钠(1.6±0.7)μg/(kg.d),氢化可的松(10.2±2.4)mg/m2,弥凝(0.11±0.03)mg/m2。中枢性甲减患儿甲状腺素用量小于先天性甲减患儿。结论ES患儿常伴MPHD,需全面激素替代治疗才能使其安全生长。有难产史或MPHD表现者应常规做下丘脑"垂体MRI,以了解其形态结构改变,协助治疗及改善预后。
Objectives To study the pituitary hormone levels and hormone replacement therapy （HRT）in children with empty sella（ES） Methods From September 1999 to March 2006,twenty（20）patients with growth retardation and diagnosis of ES by MRI were enrolled. Serum pituitary hormones were measured and the appropriate dosage of HRT was investigated. Results Eighteen（ 18）cases had dystocia history. All cases had multiple pituitary hormone deficiency（MPHD）： The serum FT4 and TSH levels of the study group were significantly lower than that of the control group. And in 12 male cases older than 10 years their serum FSH ,LH.T levels were significantly decreased （P 〈 0.001 ） ,however,E2 and PRI. were significantly increased （P 〈 0.001）. Six（6）cases were proven central diabetes insipidus by water deprivation test and MRI. The corresponding dosage of HRT for pituitary deficits was：rhGH 0.1±0.11 U/kg·d,levothyroxine 1.6 ± 0.7 μg/ kg.d,hydrocortisone 10.2 ± 2.4 mg/m^2,minirin 0.11 ± 0.03 mg/m^2. The dosage of central hypothyroidism was less than that of congenital hypothyroidism. Conclusions ES children were often associated with MPHD and need HRT. Hypothalamuspituitary MRI examination is helpful to patients with dystocia or MPHD for monitoring treatment outcomes and prognosis.
出处
《临床儿科杂志》
CAS
CSCD
北大核心
2007年第5期367-371,共5页
Journal of Clinical Pediatrics
基金
山东省人事厅2006年留学回国人员科技活动基金(No.2006178)
关键词
空蝶鞍
儿童
磁共振成像
多种垂体激素缺乏症
激素替代治疗
empty sella
children
magnetic resonance imaging
muhiple pituitary hormone deficiency
hormone replacement therapy
