Sibal Latika, Ball Steve G, Connolly Vincent, James Robert A, Kane Philip, Kelly William F, Kendall-Taylor Pat, Mathias David, Perros Petros, Quinton Richard, Vaidya Bijay
Department of Endocrinology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, UK.
Department of Endocrinology, The James Cook University Hospital, Middlesbrough, UK.
Pituitary. 2004;7(3):157-163. doi: 10.1007/s11102-005-1050-3.
To review clinical presentation, management and outcomes following different therapies in patients with pituitary apoplexy.
Retrospective analysis of case-records of patients with classical pituitary apoplexy treated in our hospitals between 1983-2004.
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.
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.
回顾垂体卒中患者接受不同治疗后的临床表现、治疗方法及预后。
对1983年至2004年间在我院接受治疗的典型垂体卒中患者的病历进行回顾性分析。
共纳入45例患者（男性28例；平均年龄49岁，范围16 - 72岁）。初诊时仅8例（18%）已知患有垂体腺瘤。34例（81%）患者初诊时存在垂体功能减退。CT和MRI分别在28%和91%的病例中发现垂体卒中。27例（60%）患者接受了手术减压，18例（40%）采取保守治疗。从就诊到手术的中位时间为6天（范围1 - 121天）。有视野缺损的患者比无这些体征的患者更有可能接受手术治疗（p = 0.01）。接受手术治疗的视力下降、视野缺损和眼肌麻痹患者中，分别有93%（13/14）、94%（15/16）和93%（13/14）实现了完全或近乎完全缓解。保守治疗组中所有视力下降（4/4）、视野缺损（4/4）和眼肌麻痹（8/8）的患者均实现了完全或近乎完全恢复。随访时手术组仅5例（19%）患者垂体功能正常，保守组为2例（11%）。手术组1例（4%）患者和保守组4例（22%）患者垂体腺瘤复发。
该大型系列研究表明，对于无神经眼科体征或仅有轻度且非进行性体征的典型垂体卒中患者，急性期可采取保守治疗。
