Pituitary apoplexy: A review of clinical presentation, management and outcome in 45 cases

被引：182

作者：

Sibal L. ^{[1
]}

Ball S.G. ^{[1
]}

Connolly V. ^{[2
]}

James R.A. ^{[1
]}

Kane P. ^{[3
]}

Kelly W.F. ^{[2
]}

Kendall-Taylor P. ^{[1
]}

Mathias D. ^{[4
]}

Perros P. ^{[1
]}

Quinton R. ^{[1
]}

Vaidya B. ^{[2
,5
]}

机构：

[1] Department of Endocrinology, Newcastle University Teaching Hospitals, Newcastle upon Tyne

[2] Department of Endocrinology, The James Cook University Hospital, Middlesbrough

[3] Department of Neurosurgery, The James Cook University Hospital, Middlesbrough

[4] Department of Otonasolaryngology, Newcastle University Teaching Hospitals, Newcastle upon Tyne

[5] Department of Endocrinology, Diabetes and Vascular Medicine, Peninsula Medical School, Royal Devon and Exeter Hospital

来源：

Pituitary | 2004年 / 7卷 / 3期

关键词：

Hypopituitarism; Pituitary adenoma; Pituitary apoplexy; Visual loss;

D O I：

10.1007/s11102-005-1050-3

中图分类号：

学科分类号：

摘要：

Objective: To review clinical presentation, management and outcomes following different therapies in patients with pituitary apoplexy. Methods: Retrospective analysis of case-records of patients with classical pituitary apoplexy treated in our hospitals between 1983-2004. Results: Forty-five patients (28 men; mean age 49 years, range 16-72 years) were identified. Only 8 (18%) were known to have pituitary adenomas at presentation. Thirty-four (81%) patients had hypopituitarism at presentation. CT and MRI identified pituitary apoplexy in 28% and 91% cases, respectively. Twenty-seven (60%) patients underwent surgical decompression, whilst 18 (40%) were managed conservatively. Median time from presentation to surgery was 6 days (range 1-121 days). Patients with visual field defects were more likely than those without these signs to be managed surgically (p = 0.01). Complete or near-complete resolution occurred in 93% (13/14), 94% (15/16) and 93% (13/14) of the surgically treated patients with reduced visual acuity, visual field deficit and ocular palsy, respectively. All patients with reduced visual acuity (4/4), visual field deficit (4/4) and ocular palsy (8/8) in the conservative group had complete or near-complete recovery. Only 5 (19%) patients in the surgical group and 2 (11%) in the conservative group had normal pituitary function at follow up. One (4%) patient in the surgical group and 4 (22%) in the conservative group had a recurrence of pituitary adenoma. Conclusions: This large series suggests that the patients with classical pituitary apoplexy, who are without neuro-ophthalmic signs or exhibit mild and non-progressive signs, can be managed conservatively in the acute stage. © Springer Science + Business Media, Inc. 2005.

引用

页码：157 / 163

页数：6

共 31 条

[1]

Brougham M., Heusner A.P., Adams R.D., Acute degenerative changes in adenomas of the pituitary body - With special reference to pituitary apoplexy, J Neurosurg, 7, pp. 421-439, (1950)

[2]

Rovit R.L., Fein J.M., Pituitary apoplexy: A review and reappraisal, J Neurosurg, 37, pp. 280-288, (1972)

[3]

Cardoso E.R., Peterson E.W., Pituitary apoplexy: A review, Neurosurgery, 14, pp. 363-373, (1984)

[4]

Reid R.L., Quigley M.E., Yen S.S., Pituitary apoplexy. A review, Arch Neurol, 42, pp. 712-719, (1985)

[5]

McFadzean R.M., Doyle D., Rampling R., Teasdale E., Teasdale G., Pituitary apoplexy and its effect on vision, Neurosurgery, 29, pp. 669-675, (1991)

[6]

Randeva H.S., Schoebel J., Byrne J., Esiri M., Adams C.B., Wass J.A., Classical pituitary apoplexy: Clinical features, management and outcome, Clin Endocrinol (Oxf), 51, pp. 181-188, (1999)

[7]

Mohanty S., Tandon P.N., Banerji A.K., Prakash B., Haemorrhage into pituitary adenomas, J Neurol Neurosurg Psychiatry, 40, pp. 987-991, (1977)

[8]

Mohr G., Hardy J., Hemorrhage, necrosis, and apoplexy in pituitary adenomas, Surg Neurol, 18, pp. 181-189, (1982)

[9]

Epstein S., Pimstone B.L., De Villiers J.C., Jackson W.P., Pituitary apoplexy in five patients with pituitary tumours, Br Med J, 2, pp. 267-270, (1971)

[10]

Ebersold M.J., Laws Jr. E.R., Scheithauer B.W., Randall R.V., Pituitary apoplexy treated by transsphenoidal surgery. A clinicopathological and immunocytochemical study, J Neurosurg, 58, pp. 315-320, (1983)

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