研究者詳細 - 益崎　裕章

論文 - 益崎　裕章

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Unequal distribution of plasma glucagon levels among clustering-based diabetes subtypes: a Japanese cohort.

Tanabe H, Shimajiri Y, Shiroma K, Higa M, Masuzaki H, Shimabukuro M

The Journal of clinical endocrinology and metabolism ( The Endocrine Society ) 2025年12月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

Abstract Context Hyperglucagonemia contributes to disturbances in glucose metabolism. Data-driven diabetes clustering reflects risk of diabetic complications better than classical classification, type 1 diabetes (T1D) vs. type 2 diabetes (T2D); however, the pathophysiological features have not been clarified. Objective To assess the distribution of plasma glucagon levels among clustering-based diabetes subtypes. Methods A total of 546 Japanese participants with T1D or T2D were categorized into five diabetes subtypes. Plasma glucagon levels were compared across subtypes and factors associated with hyperglucagonemia were evaluated using logistic regression analyses. Results Plasma glucagon levels differed significantly among diabetes subtypes. Among the five subtypes, plasma glucagon levels and the frequency of hyperglucagonemia were highest in the severe insulin-resistant diabetes (SIRD) subtype (45.6%). The SIRD subtype was an independent risk factor for hyperglucagonemia (adjusted odds ratio 2.17, 95%CI 1.03–4.54, P=0.041), even after adjusting for other risk factors, such as body mass index, HbA1c, and metabolic dysfunction-associated steatotic liver disease. Conclusion The distribution of plasma glucagon levels differed among the clustering-based diabetes subtypes. SIRD is a subtype of diabetes with a hyperglucagonemic phenotype. Elucidating the reason for hyperglucagonemia in SIRD may help to clarify the mechanisms underlying the unfavorable clinical phenotype.

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SGLT-2 Inhibitors Are Potent to Suppress Aggressive Transformation From Indolent Type of Adult T-Cell Leukemia/Lymphoma: Unique Insight Into Therapeutics for Diabetes-Related Hematological Malignancy.

Morichika K, Tamaki K, Fukushima T, Masuzaki H

EJHaem 6 ( 5 ) e70109 2025年10月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

INTRODUCTION: We previously reported that sodium-glucose co-transporter 2 (SGLT-2) was ectopically overexpressed in adult T-cell leukemia (ATL) cells notably in aggressive type but in indolent type, and widely-used anti-diabetic SGLT-2 inhibitors (SGLT-2i) considerably attenuated proliferation of leukemic cells. METHODS: We performed retrospective analyses for 10 years to see whether SGLT-2i would prevent aggressive transformation in patients with indolent type ATL accompanied by diabetes. Nucleosome occupancy in the promotor region of the SGLT-2 gene was also assessed to explore the possible involvement of epigenetic modification in such an ectopic overexpression. RESULTS: In patients of indolent ATL with diabetes, the cumulative progression rate in the non-SGLT-2i-treated group was 71%, while no patients developed aggressive transformation in the SGLT-2i treated group. ATL cells showed an apparent trend to decrease nucleosome occupancy in the promotor region of the SGLT-2 gene. CONCLUSION: Our data suggest that SGLT-2i is advantageous for preventing aggravative transformation in indolent ATL. TRIAL REGISTRATION: Authors confirmed that clinical trial registration was not requested for the present study and this manuscript.

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Extranodal natural killer/T-cell lymphoma with lung involvement in a young adult with suspected mosquito bite hypersensitivity: A case report.

Higa M, Atsumi E, Hoshino H, Yamashiro M, Nakajima T, Tomita M, Masuzaki H, Wada N, Owan I

Respiratory investigation ( Respiratory Investigation ) 63 ( 5 ) 872 - 876 2025年07月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

A young adult with suspected pulmonary lymphoma was diagnosed with extranodal natural killer/T-cell lymphoma (ENKTL). The patient had a history of possible mosquito bite hypersensitivity (MBH), suggesting a potential association between MBH and ENKTL. Although ENKTL typically affects middle-aged adults, it has rarely been reported in children with MBH or chronic active Epstein-Barr virus (EBV) disease. This case highlights the challenges of obtaining pathological confirmation from small biopsy samples of pulmonary ENKTL. Detailed history taking and EBV DNA testing may aid in diagnosis, particularly in younger patients.

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Adjunct Therapy with Ipragliflozin Exerts Limited Effects on Kidney Protection in Type 1 Diabetes: A Retrospective Study Conducted at 25 Centers in Japan (IPRA-CKD).

Nakamura Y, Horie I, Yano H, Nomoto H, Fukui T, Yuyama Y, Kawamura T, Ueda M, Yamamoto A, Hirota Y, Kusunoki Y, Nishida K, Sekiguchi D, Maeda Y, Minami M, Nagayama A, Iwata S, Minagawa H, Furukawa S, Miyake T, Ueno H, Chinen R, Nakayama Y, Masuzaki H, Miyachi Y, Okada Y, Okamoto M, Ono K, Tanaka KI, Kurozumi A, Sakai T, Yamasaki H, Yasui JI, Ito A, Kawakami A, Abiru N, IPRA-CKD Study Group

Biomedicines ( Biomedicines ) 13 ( 6 ) 2025年05月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

Background/Objectives: While sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated additional non-glycemic benefits for renal protection in individuals with type 2 diabetes, less evidence is available for those with type 1 diabetes (T1D). To determine whether the adjunctive use of the SGLT2 inhibitor ipragliflozin confers kidney protection in individuals with T1D, we retrospectively analyzed data from a real-world cohort examined at 25 centers in Japan. Methods: We enrolled 359 subjects aged 20-74 years with T1D (IPRA group: 159 ipragliflozin users; control [CTRL] group: 200 non-users). The primary outcome was changes in the estimated glomerular filtration rate (eGFR) from baseline to 24 months after the initiation of ipragliflozin. The secondary outcomes were all other changes, including the urinary albumin-creatinine ratio (UACR) and urinary protein-creatinine ratio (UPCR). Results: The IPRA group's eGFR decline slopes were 0.79 mL/min/1.73 m2/year milder than the CTRL group's after propensity score matching, but this difference was not significant. The subjects complicated by chronic kidney disease (CKD) defined as UACR ≥ 30 mg/g and/or UPCR ≥ 0.5 g/g and/or eGFR < 60 mL/min/1.73 m2 showed changes in UPCR (g/g) from baseline to 24 months that were significantly lower in the IPRA group (-0.27 ± 1.63) versus the CTRL group (0.18 ± 0.36) (p = 0.016). No significant increase in adverse events (including severe hypoglycemia and hospitalization due to ketosis/ketoacidosis or cardiovascular diseases) was observed in the IPRA group. Conclusions: Adjunctive treatment with ipragliflozin exerted potential renal benefits by decreasing proteinuria in T1D subjects with CKD. Further investigations are required to determine whether its additional benefits exceed the increased risk of ketoacidosis.

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Two Cases of Plasmablastic Myeloma Mimicking Plasmablastic Lymphoma With In-Depth Review of Literature.

Kitamura S, Morichika K, Nakachi S, Hanashiro T, Miyagi R, Nakajima T, Nishi Y, Tamaki K, Fukushima T, Masuzaki H

Cancer reports (Hoboken, N.J.) ( Cancer Reports ) 8 ( 2 ) e70094 2025年02月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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Association between low serum testosterone level and severe asthma among elderly women

Ryu K.

Allergology International ( Allergology International ) 74 ( 3 ) 453 - 460 2025年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

Background: Elderly asthma has distinct pathophysiologic and phenotypic characteristics compared with asthma in younger patients. However, a potential relationship between sex hormones and the severity of asthma remains unknown in the elderly population. The aim of the present study was to elucidate the relationship between the level of circulating free testosterone and severity of asthma among Japanese with elderly asthma.Methods: The level of free testosterone was measured using sera from elderly patients with asthma aged ≥60 years (n = 192), and its association with the severity of asthma was examined after stratification by sex.Results: Based on previous literature and our preliminary analysis showing that current oral corticosteroid (OCS) use might be a risk factor for a lower free testosterone level regardless of severity of asthma, analyzed patients were limited to those who were not currently using OCS (n = 164). Regarding elderly men who were not currently using OCS (n = 62), there was no significant association between free testosterone level and severity of asthma. However, in female counterparts (n = 102), a low free testosterone level was significantly associated with severe asthma even after adjustment for age (p for trend, 0.03).Conclusions: The present study showed a significant association between the serum free testosterone level and severity of asthma among elderly women who were not currently using OCS. Although the causal relationship is unclear, this finding may provide a clue to understand the sex difference in the mechanisms of severe asthma in elderly populations.

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[Intramuscular abscess and multiple lymphadenitis due to Nocardia asiatica infection requiring differential diagnosis from smoldering adult T-cell leukemia/lymphoma].

Yamashiro M, Nakajima T, Irei Y, Miyagi R, Kitamura S, Tamaki K, Nishi Y, Morichika K, Nakachi S, Maehara H, Fukushima T, Masuzaki H

[Rinsho ketsueki] The Japanese journal of clinical hematology ( 一般社団法人日本血液学会 ) 66 ( 2 ) 121 - 126 2025年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

左上腕三頭筋の腫瘤を主訴に来院した72歳男性。切開術を施行し排膿を認めた。病理検査で悪性所見はなく起因微生物の同定にも到らずcefazolinも無効であった。追加のCT検査で全身性リンパ節腫脹を，血液検査でHTLV-1抗体を検出。末梢血単核球でHTLV-1プロウイルスのモノクロナリティを確認した。左腋窩リンパ節の再生検でも異常細胞は確認されず成人T細胞白血病・リンパ腫くすぶり型と診断。膿培養の延長を行いNocardia sp.を検出。16S rRNA解析でNocardia asiaticaを同定。薬剤感受性試験の結果を踏まえてST合剤とminocyclineを開始し，3ヶ月で全身性リンパ節腫脹は改善した。多発リンパ節腫脹を呈するNocardia asiatica感染症の報告は極めて稀であるが免疫能低下を背景とした全身性リンパ節腫脹の鑑別診断で考慮することが重要である。

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沖縄県における造血幹細胞移植医療の現状

仲地佐和子, 北村紗希子, 森近一穂, 中島知, 宮城理子, 上間道仁, 横田雄太郎, 宮城敬, 狩俣かおり, 山入端敦, 大濵昌代, 友寄未希, 友寄毅昭, 福島卓也, 益崎裕章

日本造血・免疫細胞療法学会雑誌 ( 一般社団法人日本造血・免疫細胞療法学会 ) 14 ( 3 ) 130 - 134 2025年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

沖縄県では1990年代より血縁者間骨髄移植が行われるようになり2000年以降は年間約40例で推移している。沖縄県の移植医療の特徴として離島や僻地の医療を担う責務に加え，難治性で移植が必要な成人T細胞白血病リンパ腫（ATL）患者の頻度が高く血液悪性腫瘍に対する移植医療のニーズに対応する県内完結型の医療体制が不可欠であることが挙げられる。医療事故や血液内科医の不足から琉球大学病院における造血幹細胞移植はこれまでに2度の中断を余儀なくされ，バンクを介した移植が実施出来ない時期が長く続き，患者は経済的・精神的・身体的に大きな負担を強いられてきた。その後，非血縁者間移植施設の認定を再取得し，現在では沖縄県内の血液内科専門8施設中，唯一，琉球大学病院のみで実施している。沖縄県の移植医療の経緯と今後の課題について概説する。

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Precision HealthとPrecision Nutritionが拓く100年健康長寿の未来

益崎裕章

糖尿病と妊娠 25 2025年

掲載種別: 研究論文（学術雑誌）

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Editorial: Nutrient signaling and neuroendocrine pathways in brain-organ communication.

Aizawa H, Masuzaki H

Frontiers in molecular neuroscience ( Frontiers in Molecular Neuroscience ) 18 1711443 2025年 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

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令和６年度アカデミア賞受賞記念講演健康長寿を実現する脳科学・機能性食品科学の分子医学的アプローチと社会実装の展開

益崎裕章

会誌ACADEMIA 199 53 - 77 2025年

掲載種別: 研究論文（研究会，シンポジウム資料等）

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A Rare Case of Autoimmune-Mediated Lecithin:Cholesterol Acyltransferase Insufficiency Manifesting as the Acute Onset of Extremely Hypo-High-Density Lipoprotein-Cholesterolemia and Spontaneous Improvement: A Case Report with a Review of the Literature.

Tamaki A, Kuroda M, Yonaha K, Ishiki Y, Uehara M, Nakayama Y, Honma KI, Chinen R, Uema T, Okamoto S, Miyoshi J, Kirinashizawa M, Sato K, Aohara T, Yamamoto M, Maezawa Y, Yokote K, Masuzaki H

Journal of atherosclerosis and thrombosis ( 一般社団法人日本動脈硬化学会 ) advpub ( 0 ) 649 - 659 2024年12月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

A 59-year-old Japanese woman was referred for an extremely low level of circulating high-density lipoprotein cholesterol (HDL-C). The serum HDL-C level had long been within the normal range but suddenly decreased asymptomatically to 7 mg/dL. She had no typical symptoms associated with familial lecithin, cholesterol acyltransferase deficiency (FLD), including proteinuria, anemia, and corneal opacity. The circulating level of ApoA-1 was also markedly decreased at 48 mg/dL, and the proportion of esterified cholesterol to free cholesterol was irregularly low at 26%. Whole-genome sequencing revealed no apparent pathological mutations in the LCAT gene. Notably, anti-LCAT antibodies were detected in the serum at 146±1.7 ng/mL, resulting in her being diagnosed with acquired LCAT insufficiency (ALCATI) caused by anti-LCAT antibodies. Five years after her HDL-C levels spontaneously decreased, they increased without any identifiable cause. To our knowledge, only six cases of ALCATI caused by anti-LCAT antibodies have been reported to date. In contrast to the present case, previously reported cases of ALCATI manifested proteinuria that improved with steroid therapy. The unique clinical course in the present case highlights the heterogeneity of ALCATI, warranting further research to clarify the molecular pathophysiology of FLD and ALCATI.

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Machine learning-based reproducible prediction of type 2 diabetes subtypes.

Tanabe H, Sato M, Miyake A, Shimajiri Y, Ojima T, Narita A, Saito H, Tanaka K, Masuzaki H, Kazama JJ, Katagiri H, Tamiya G, Kawakami E, Shimabukuro M

Diabetologia ( Diabetologia ) 67 ( 11 ) 2446 - 2458 2024年08月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

AIMS/HYPOTHESIS: Clustering-based subclassification of type 2 diabetes, which reflects pathophysiology and genetic predisposition, is a promising approach for providing personalised and effective therapeutic strategies. Ahlqvist's classification is currently the most vigorously validated method because of its superior ability to predict diabetes complications but it does not have strong consistency over time and requires HOMA2 indices, which are not routinely available in clinical practice and standard cohort studies. We developed a machine learning (ML) model to classify individuals with type 2 diabetes into Ahlqvist's subtypes consistently over time. METHODS: Cohort 1 dataset comprised 619 Japanese individuals with type 2 diabetes who were divided into training and test sets for ML models in a 7:3 ratio. Cohort 2 dataset, comprising 597 individuals with type 2 diabetes, was used for external validation. Participants were pre-labelled (T2Dkmeans) by unsupervised k-means clustering based on Ahlqvist's variables (age at diagnosis, BMI, HbA1c, HOMA2-B and HOMA2-IR) to four subtypes: severe insulin-deficient diabetes (SIDD), severe insulin-resistant diabetes (SIRD), mild obesity-related diabetes (MOD) and mild age-related diabetes (MARD). We adopted 15 variables for a multiclass classification random forest (RF) algorithm to predict type 2 diabetes subtypes (T2DRF15). The proximity matrix computed by RF was visualised using a uniform manifold approximation and projection. Finally, we used a putative subset with missing insulin-related variables to test the predictive performance of the validation cohort, consistency of subtypes over time and prediction ability of diabetes complications. RESULTS: T2DRF15 demonstrated a 94% accuracy for predicting T2Dkmeans type 2 diabetes subtypes (AUCs ≥0.99 and F1 score [an indicator calculated by harmonic mean from precision and recall] ≥0.9) and retained the predictive performance in the external validation cohort (86.3%). T2DRF15 showed an accuracy of 82.9% for detecting T2Dkmeans, also in a putative subset with missing insulin-related variables, when used with an imputation algorithm. In Kaplan-Meier analysis, the diabetes clusters of T2DRF15 demonstrated distinct accumulation risks of diabetic retinopathy in SIDD and that of chronic kidney disease in SIRD during a median observation period of 11.6 (4.5-18.3) years, similarly to the subtypes using T2Dkmeans. The predictive accuracy was improved after excluding individuals with low predictive probability, who were categorised as an 'undecidable' cluster. T2DRF15, after excluding undecidable individuals, showed higher consistency (100% for SIDD, 68.6% for SIRD, 94.4% for MOD and 97.9% for MARD) than T2Dkmeans. CONCLUSIONS/INTERPRETATION: The new ML model for predicting Ahlqvist's subtypes of type 2 diabetes has great potential for application in clinical practice and cohort studies because it can classify individuals with missing HOMA2 indices and predict glycaemic control, diabetic complications and treatment outcomes with long-term consistency by using readily available variables. Future studies are needed to assess whether our approach is applicable to research and/or clinical practice in multiethnic populations.

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Young-onset type 2 diabetes mellitus enhances proteinuria, but not glomerular filtration rate decline: A Japanese cohort study.

Saito H, Tanabe H, Hirai H, Higa M, Tanaka K, Yamaguchi S, Maimaituxun G, Masuzaki H, Kazama JJ, Shimabukuro M

Journal of diabetes investigation ( Journal of Diabetes Investigation ) 15 ( 10 ) 1444 - 1456 2024年07月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

AIMS/INTRODUCTION: The time course of chronic kidney disease in young-onset type 2 diabetes mellitus remains unclear. We compared the trajectories of proteinuria and estimated glomerular filtration rate (eGFR) decline between young-onset (aged ≤40 years) and late-onset (aged >40 years) type 2 diabetes mellitus in a Japanese multicenter cohort. MATERIALS AND METHODS: Participants without diabetic kidney disease were divided into two groups according to age at diagnosis: young- and late-onset. The primary endpoint was eGFR <60 mL/min/1.73 m2, proteinuria or both. Multivariable Cox proportional hazards were calculated to estimate incidence. RESULTS: Among 626 participants with type 2 diabetes mellitus, 78 (12.4%) had young-onset and 548 (87.6%) had late-onset diabetes. The incidence of eGFR <60 mL/min/1.73 m2 was lower (16.7% vs 33.5%, P = 0.003), but that of proteinuria was higher (46.2% vs 28.9%, P = 0.002) in the young-onset type 2 diabetes mellitus group. The Kaplan-Meyer curve showed that young-onset type 2 diabetes mellitus was associated with a decreased hazard ratio (HR) for eGFR <60 mL/min/1.73 m2 and an increased HR for proteinuria compared with late-onset type 2 diabetes mellitus. In the multivariate Cox analysis, young-onset type 2 diabetes mellitus increased the HR (95% confidence interval) of proteinuria (1.53, 95% confidence interval 1.03-2.26), but did not change the eGFR <60 mL/min/1.73 m2 HR. CONCLUSIONS: Young-onset type 2 diabetes mellitus has a lower HR of eGFR <60 mL/min/1.73 m2 and an increased HR of proteinuria compared with late-onset type 2 diabetes mellitus, indicating that young-onset type 2 diabetes mellitus has a different time course for the development of proteinuria and subsequent eGFR decline.

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Gut microbiota-based prediction for the transition from normal glucose tolerance (NGT) to impaired glucose tolerance (IGT) in a remote island cohort study.

Uema T, Tsukita M, Okamoto S, Uehara M, Honma KI, Nakayama Y, Tamaki A, Miyazato M, Ashikari A, Maeda S, Imamura M, Matsushita M, Nakamura K, Masuzaki H

Diabetes research and clinical practice ( Diabetes Research and Clinical Practice ) 213 111747 - 111747 2024年07月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

AIM: The present cohort study explored whether specific gut microbiota (GM) profile would predict the development of impaired glucose tolerance (IGT) in individuals with normal glucose tolerance (NGT). METHODS: A total of 114 study subjects with NGT in Kumejima island, Japan participated in the present study and underwent 75 g oral glucose tolerance tests at baseline and one year later. We compared the profile of GM at baseline between individuals who consistently maintained NGT (NRN, n = 108) and those who transitioned from NGT to IGT (NTI, n = 6). RESULTS: Within-individual bacterial richness and evenness as well as inter-individual bacterial composition showed no significant differences between NRN and NTI. Of note, however, partial least squares discriminant analyses revealed distinct compositions of GM between groups, with no overlap in their 95 % confidence interval ellipses. Multi-factor analyses at the genus level demonstrated that the proportions of CF231, Corynebacterium, Succinivibrio, and Geobacillus were significantly elevated in NTI compared to NRN (p < 0.005, FDR < 0.1, respectively) after adjusting for age, sex, HbA1c level, and BMI. CONCLUSIONS: Our data suggest that increased proportion of specific GM is linked to the future deterioration of glucose tolerance, thereby serving as a promising predictive marker for type 2 diabetes mellitus.

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Impact of the transition from radioimmunoassay (RIA) to chemiluminescent enzyme immunoassay (CLEIA) for the measurement of plasma aldosterone concentration (PAC) on the diagnosis of primary aldosteronism (PA) via retrospective analyses in Okinawa, Japan.

Honma KI, Nakayama Y, Tamaki A, Uehara M, Teruya T, Yabiku T, Ishiki Y, Yonaha K, Chinen R, Uema T, Okamoto S, Masuzaki H

Endocrine journal ( 一般社団法人日本内分泌学会 ) advpub ( 0 ) 895 - 906 2024年06月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

In Japan, the traditional method for measuring plasma aldosterone concentration (PAC) was radioimmunoassay (RIA), which had several challenges, including poor traceability of certified reference materials and reduced detection sensitivity at low concentrations. To overcome these issues, a chemiluminescent enzyme immunoassay (CLEIA) for PAC measurement was introduced in April 2021 and the Japan Endocrine Society published new guidelines for primary aldosteronism (PA). This study aimed to evaluate the impact of the transition from RIA to CLEIA for PAC measurement on PA diagnosis. Data from 190 patients admitted to the Second Department of Internal Medicine, University of the Ryukyus Hospital, between April 2012 and March 2021 were analyzed. Patients who were diagnosed with PA underwent adrenal venous sampling. The PAC measured by RIA (PAC(RIA)) was converted to the estimated PAC measured by CLEIA (ePAC(CLEIA)) using a conversion formula. The present study evaluated the discordance rates in diagnoses based on screening (SC), captopril challenge test (CCT), saline infusion test (SIT), and diagnosis of PA between results judged by PAC(RIA) according to the previous guidelines and those judged by ePAC(CLEIA) according to the new guidelines. The results revealed discordant diagnosis rates of 6.4% for SC and 10.1% for CCT, with no discordance for SIT. The discordant diagnosis rate for PA was 3.7%. Our study reveals the challenges in establishing appropriate diagnostic criteria for PA using PAC(CLEIA) and highlights the demand for further research on provisionally positive categories.

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座談会高尿酸血症と合併症～CVD残余リスクとして薬剤介入を考える～

益崎裕章, 今田恒夫, 田中敦史

診断と治療 ( 診断と治療社 ) 112 ( 6 ) 773 - 778 2024年06月

掲載種別: 研究論文（学術雑誌）

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Post-traumatic pituitary stalk transection syndrome (PSTS) expeditiously manifested after a fall from a height combined with acute traumatic spinal cord injury: a rare case report with review of literature.

Ishiki Y, Tamaki A, Honma KI, Yonaha K, Yabiku T, Teruya T, Uehara M, Nakayama Y, Chinen R, Uema T, Nakachi S, Okamoto S, Masuzaki H

Endocrine journal ( 一般社団法人日本内分泌学会 ) advpub ( 0 ) 817 - 824 2024年05月 [ 査読有り ]

掲載種別: 研究論文（学術雑誌）

Post-traumatic pituitary stalk transection syndrome (PSTS) is an extremely rare cause of combined pituitary hormone deficiency (CPHD), affecting approximately 9 per 100,000 cases of traumatic brain injury. In contrast, pituitary stalk interruption syndrome (PSIS) is also a rare cause of CPHD. Importantly, these conditions are often confused due to their similar names and resembling findings on magnetic resonance imaging (MRI). PSIS has been thought to be a prenatal developmental event resulting from a couple of genetic aberrations. In typical PSIS, anterior pituitary hormone deficiencies are restricted to growth hormone (GH) and gonadotropin during the pediatric age, gradually and generally progressing to panhypopituitarism in most cases. In contrast, global deficiencies of the anterior pituitary hormones in PSTS are temporally associated with trauma. To the best of our knowledge, no case reports of PSTS combined with acute traumatic spinal cord injury have been reported. A 34-year-old female was transferred to our hospital after jumping from the fourth building floor. She was diagnosed as an acute traumatic spinal cord injury and underwent the operation of elective posterior spinal fusion. On postoperative day 7, the blood tests revealed considerable hyperkalemia, hyponatremia and eosinophilia. Notably, menstruation stopped after falling from a height. Pituitary function tests revealed GH deficiency, hypogonadism, hypothyroidism and hypoadrenocorticism. MRI revealed loss of the pituitary stalk, whilst the hyperintense signal from distal axon of hypothalamus was still identified. Based on these findings, she was diagnosed as PSTS. Our case highlights endocrinological landscape of transection of the pituitary stalk by acute trauma.

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