Dobrovsky Viviana, García Alejandro J, Artese Rosa, Bruno Oscar D
División Endocrinología, Hospital de Clínicas José de San Martín, Facultad de Medicina, Universidad de Buenos Aires, Argentina.
Medicina (B Aires). 2003;63(4):307-10.
Although infrequent, recovery of pituitary function after necrosis of a pituitary adenoma is not an exceptional event. We report the case of a 32-year-old woman with previous surgery for an adrenal mass and signs of hypercortisolism which failed to revert postoperatively. She then developed pituitary apoplexy followed by hypopituitarism, as confirmed by hormonal measurements. Magnetic resonance imaging (MRI) showed evidence of a pituitary macroadenoma with signs of necrosis, impinging on the optic chiasm, which was excised by the trans-sphenoidal approach. Nine months later, hormone tests indicated a near total recovery of pituitary functions. The patient had a successful pregnancy three years later. After a 5-year follow-up, she remained clinically asymptomatic, with moderate reduction in cortisol and blunted growth hormone (GH) response to hypoglycemia and MRI failed to disclose any residual tumor, except for a partial arachnoidocele.
尽管垂体腺瘤坏死后脑垂体功能恢复的情况并不常见，但也并非罕见。我们报告了一例32岁女性病例，该患者曾因肾上腺肿块接受手术，术后仍有高皮质醇血症的体征。激素测量证实，她随后发生了垂体卒中，继而出现垂体功能减退。磁共振成像（MRI）显示有一个垂体大腺瘤并有坏死迹象，压迫视交叉，经蝶窦入路将其切除。九个月后，激素检测表明垂体功能几乎完全恢复。三年后，该患者成功怀孕。经过5年的随访，她临床无症状，皮质醇略有降低，对低血糖的生长激素（GH）反应减弱，MRI未发现任何残留肿瘤，仅见部分蛛网膜囊肿。
