以尿崩症为首发表现的垂体转移性肿瘤临床特征分析

摘要

目的 分析以尿崩症为首发表现的垂体转移性肿瘤(PM)患者的临床特征,以期提高对PM与尿崩症关系的认识,避免误诊与漏诊.方法 选取2016年11月安徽医科大学第一附属医院内分泌科收治的1例以尿崩症为首发表现的肺癌伴垂体转移患者为研究对象.以"pituitar*/hypophys*""metasta*""diabetes insipidus""垂体""转移""尿崩症"为关键词,检索PubMed、ISI Web of Knowledge、中国知网、万方数据知识服务平台,检索时间限定为1990年1月—2017年10月,筛选报道以尿崩症为首发表现病例的文献并结合本院收治1例患者的临床资料进行回顾性分析.结果检索并筛选得到符合标准的文献31篇,患者41例,结合本例共42例,其中男24例、女18例;平均年龄(56.6±12.7)岁;患者原发病均为恶性肿瘤,其中41例患者经病理学检查确诊,1例患者经胸部CT结合血清肿瘤标志物检查诊断为肺癌.PM主要临床表现为多尿、烦渴、头痛.影像学检查发现41例患者有明确的鞍区占位,29例患者存在2个以上部位肿瘤转移;26例患者腺垂体激素分泌不足;11例患者电解质平衡紊乱.42例患者预后均较差,中位生存时间为6.0个月, 1年、3年累积生存率分别为22.1%、17.7%.结论 PM是一种少见且预后较差的肿瘤相关并发症,尿崩症可作为PM患者的首发表现,甚至唯一症状.对于新近发生尿崩症的中老年患者,应积极寻找病因,重视系统性疾病的影响并考虑肿瘤垂体转移可能.%Objective To analyze the clinical characteristics of pituitary metastasis(PM) with diabetes insipidus as the initial manifestation,so as to improve clinicians' capabilities in the differential diagnosis of this disease from diabetes insipidus,avoiding the incidence of misdiagnosis and missed diagnosis.Methods In November 2016,one male patient was admitted to Department of Endocrinology,the First Affiliated Hospital of Anhui Medical University due to pituitary metastasis from lung cancer with diabetes insipidus as the initial manifestation.Meanwhile,using the search terms("pituitar*/hypophys*""metasta*" combined with "diabetes insipidus" or "垂体" "转移" combined with"尿崩症"),we searched PubMed,ISI Web of Knowledge,CNKI,and Wanfang Data Knowledge Service Platform for studies about PM with diabetes insipidus as the initial manifestation published between January 1990 and October 2017.We conducted a retrospective analysis of the clinical data of the cases involved in the included studies and the male case treated by us.Results Thirty-one articles were included,involving 41 cases.So totaled 42 cases enrolled after adding our case,and the data of them were summarized as follows:distribution of sex:24 males and 18 females;mean age:(56.6±12.7) years old;primary disease:malignant tumor;diagnostic pathway:41 patients by pathological examination,the other 1 by the combination of chest CT and serum tumor markers;main clinical manifestations:polyuria,polydipsia,and headache;imaging findings:lesions in sellar region were identified in 41 cases,and the tumor had metastasized to more than 2 sites in 29 cases;laboratory findings:insufficient secretion of hormone in the anterior pituitary was found in 26 cases,and electrolyte disorders in 11 cases;outcome:all showed poor outcome,with a median survival time of 6.0 months,1-year cumulative survival rate of 22.1%,and 3-year cumulative survival rate of 17.7%.Conclusion PM is a rare tumor-related complication with poor prognosis.Diabetes insipidus could be the initial manifestation and even the only symptom of these patients.Therefore,for a middle-aged or elderly patient with new-onset diabetes insipidus,diagnosis should be performed based on identifying the primary disease,and considering the effect of systemic disease as well as PM.