本文選題：糖尿病　切入點(diǎn)：垂體功能減退　出處：《鄭州大學(xué)》2017年碩士論文

【摘要】：背景與目的Houssay綜合征又稱糖尿病合并垂體功能減退癥,為Bernardo Alberto Houssay(1887-1971)所發(fā)現(xiàn)率先提出,1925年,Houssay發(fā)現(xiàn),在切除胰腺產(chǎn)生糖尿病的小狗,若同時(shí)切除垂體可減少或阻止糖尿病的發(fā)生;而注射垂體提取物可產(chǎn)生糖尿病或加重糖尿病的嚴(yán)重性。這種發(fā)現(xiàn)被稱為“Houssay現(xiàn)象”。此后,Houssay在20世紀(jì)30年代關(guān)注了腺垂體與糖尿病直接的關(guān)系[1]。在糖尿病基礎(chǔ)上由于各種原因如腫瘤、炎癥、缺血等所引起起的腺垂體功能減退稱為Houssay綜合征。其表現(xiàn)隱匿,經(jīng)常誤診漏診,最終可導(dǎo)致嚴(yán)重的后果。因此此病的預(yù)防和治療越來(lái)越受到關(guān)注。Houssay綜合征個(gè)案報(bào)道較多,臨床大量病例分析并不多見(jiàn),因此對(duì)鄭州大學(xué)第一附屬醫(yī)院近十多年臨床上遇到的確診為Houssay綜合征患者進(jìn)行回顧性分析總結(jié),探討其發(fā)病機(jī)制、臨床特點(diǎn)、治療及預(yù)后等情況。方法回顧性概括總結(jié)鄭州大學(xué)第一附屬醫(yī)院2005年1月至2016年1月期間本院確診的21例Houssay綜合征的患者的臨床資料。入組標(biāo)準(zhǔn):(1)符合1999年世界衛(wèi)生組織(WHO)提出的2型糖尿病診斷標(biāo)準(zhǔn),(2)經(jīng)常反復(fù)出現(xiàn)低血糖,停用胰島素及減少降糖藥物低血糖難以糾正,并且最后確定低血糖原因?yàn)榇贵w功能減退所致者;(3)病史、體征及測(cè)定下丘腦-垂體-靶腺軸(甲狀腺、腎上腺、性腺)激素水平及功能試驗(yàn)均提示垂體功能減退者;(3)排除原發(fā)性甲狀腺功能減退、Addison病、自身免疫性多發(fā)內(nèi)分泌腺病綜合征(APS)、肝病、腹瀉等胃腸道疾病者。結(jié)果1.一般數(shù)據(jù):21例Houssay綜合征患者,9例男性,12例女性,男:女=1:1.33;年齡25-78歲,中位年齡60.05歲,其中20-30歲1例,30-60歲9例,大于60歲10例。病程:初診3例,5個(gè)月-6年12例,6-16年6例。垂體瘤2例,希恩綜合征4例,顱咽管瘤1例,特發(fā)14例;2.臨床表現(xiàn):21例患者均易反復(fù)出現(xiàn)低血糖癥狀;2例入院時(shí)有腎上腺危象,脫水伴有低血壓,虛脫無(wú)力,惡心嘔吐,呈嗜睡狀態(tài);6例患者出現(xiàn)貧血;18例入院時(shí)有低鈉血癥。4例伴只伴有甲減者怕冷少汗,毛發(fā)稀疏,皮膚干燥,記憶力減退等;7例只伴有腎上腺功能減退者疲乏無(wú)力、易感染;2例甲狀腺功能減退合并腎上腺皮質(zhì)功能減退者;余8例全垂體功能減退患者;其中入院時(shí)2例被誤診為APS,1例被誤診為腫瘤;3.實(shí)驗(yàn)室檢查:(1)21例患者均發(fā)生過(guò)低血糖,當(dāng)時(shí)急查血糖2.15±0.82mmol/l;(2)入院時(shí):高血鉀2例,低血鉀1例,余處于正常范圍,均值4.85±0.36mmol/l;6例貧血,余處于正常范圍,血紅蛋白:116.71±19.56g/l,;低血鈉18例,血鈉:131.57±4.75mmol/l;TC:4.52±1.05 mmol/l;TG:1.73±0.67mmol/l;ALT:24.33±7.26 U/L;AST:23.38±8.59U/L;(3)21例中共伴有甲狀腺功能低下者14例,伴有腎上腺皮質(zhì)功能低下者17例,伴有性腺功能低下者8例,FT3:3.30±0.54pmol/l,FT4:5.76±2.61 pmol/l,TSH低于正常范圍者14例,TSH:0.90±1.056u IU/ml;ACTH(8:00):6.48±4.410pg/ml,COR(8:00):79.11±50.43ng/ml,UFC低于正常范圍者17例,UFC:73.81±43.07nmol/d;FSH11.08±3.29m IU/ml,LH:8.69±1.91m IU/ml;(4)垂體MRI表現(xiàn):18例垂體顯著縮小,垂體變薄;4.統(tǒng)計(jì)患者口服激素替代治療前與治療7天后空腹胰島素水平,兩樣本量資料比較應(yīng)用配對(duì)樣本t檢驗(yàn),p0.05為差異有統(tǒng)計(jì)學(xué)意義;甲狀腺功能減退者,通過(guò)激素替代治療后,FT3和TSH治療前后相比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05),而治療前后相比較FT4差異均有統(tǒng)計(jì)學(xué)意義(P0.05);腎上腺功能減退者,通過(guò)激素替代治療后,UFC治療前后相比較差異有統(tǒng)計(jì)學(xué)意義(P0.05);COR和ACTH治療前后相比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);血紅蛋白、肝功能、血脂治療前后相比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05);血鈉、血鉀治療前后相比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)結(jié)論1.糖尿病合并垂體功能減退癥臨床上并不少見(jiàn)。2.糖尿病合并垂體功能減退癥臨床上較易誤診漏診,最終延遲治療。
[Abstract]:Background and objective Houssay syndrome and pituitary function in diabetic patients with hypothyroidism known as Bernardo Alberto, Houssay (1887-1971) found first proposed in 1925, Houssay found that after resection of the pancreas to produce diabetic dog, if resection of pituitary can reduce or prevent the occurrence of diabetes; while the injection of pituitary extract can cause diabetes or more severe diabetes. This finding is known as the "Houssay phenomenon". Since then, Houssay focuses on [1]. relationship of pituitary gland in diabetes and diabetes directly based on due to various reasons such as tumor, inflammation in 1930s, pituitary gland ischemia caused by the loss is called Houssay syndrome. Its occult symptoms, often misdiagnosed finally, can lead to serious consequences. Therefore, the prevention and treatment of the disease more and more attention to the.Houssay syndrome case report more, a large amount of clinical case Analysis is rare, so to meet nearly more than 10 years of Clinical First Affiliated Hospital of Zhengzhou University on the diagnosis of patients with Houssay syndrome were analyzed retrospectively, to investigate the pathogenesis, clinical characteristics, treatment and prognosis. Methods a retrospective summary of the First Affiliated Hospital of Zhengzhou University from January 2005 to January 2016 during the period of clinical data confirmed in our hospital 21 cases of Houssay syndrome patients. Inclusion criteria: (1) with the 1999 WHO (WHO) proposed the diagnostic criteria of type 2 diabetes mellitus (2), repeated hypoglycemia, discontinuation of insulin and hypoglycemic drugs reduce hypoglycemia, it is difficult to correct, and finally determine the cause of hypoglycemia caused by pituitary dysfunction; (3) the history, signs and determination of the hypothalamus pituitary gonad axis (thyroid, adrenal and gonadal hormone levels) and functional test showed pituitary dysfunction; (3) excluding primary 鐢茬姸鑵哄姛鑳藉噺閫，

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