Lee Jung-Sup, Park Yong-Sook, Kwon Jeong-Taik, Nam Taek-Kyun, Lee Tae-Jin, Kim Jae-Kyun
Department of Neurosurgery, College of Medicine, Chung-Ang University, Seoul, Korea.
J Korean Neurosurg Soc. 2011 Oct;50(4):281-7. doi: 10.3340/jkns.2011.50.4.281. Epub 2011 Oct 31.
Pituitary apoplexy is life-threatening clinical syndrome caused by the rapid enlargement of a pituitary tumor due to hemorrhage and/or infarction. The pathogenesis of pituitary apoplexy is not completely understood. We analyzed the magnetic resonance imaging (MRI) of pituitary tumors and subsequently correlated the radiological findings with the clinical presentation. Additionally, immunohistochemistry was also performed to determine whether certain biomarkers are related to radiological apoplexy.
Thirty-four cases of pituitary adenoma were enrolled for retrospective analysis. In this study, the radiological apoplexy was defined as cases where hemorrhage, infarction or cysts were identified on MRI. Acute clinical presentation was defined as the presence of any of the following symptoms: severe sudden onset headache, decreased visual acuity and/or visual field deficit, and acute mental status changes. Angiogenesis was quantified by immunohistochemical expression of fetal liver kinase 1 (Flk-1), neuropilin (NRP) and vascular endothelial growth factor (VEGF) expression, while microvascular density (MVD) was assessed using Endoglin and CD31.
Clinically, fourteen patients presented with acute symptoms and 20 for mild or none clinical symptoms. Radiologically, fifteen patients met the criteria for radiological apoplexy. Of the fifteen patients with radiologic apoplexy, 9 patients presented acute symptoms whereas of the 19 patient without radiologic apoplexy, 5 patients presented acute symptoms. Of the five biomarkers tracked, only VEGF was found to be positively correlated with both radiological and nonradiological apoplexy.
While pituitary apoplexy is currently defined in cases where clinical symptoms can be histologically confirmed, we contend that cases of radiologically identified pituitary hemorrhages that present with mild or no symptoms should be designated subacute or subclinical apoplexy. VEGF is believed to have a positive correlation with pituitary hemorrhage. Considering the high rate of symptomatic or asymptomatic pituitary tumor hemorrhage, additional studies are needed to detect predictors of the pituitary hemorrhage.
垂体卒中是一种因垂体肿瘤因出血和/或梗死而迅速增大所导致的危及生命的临床综合征。垂体卒中的发病机制尚未完全明确。我们分析了垂体肿瘤的磁共振成像（MRI），并将影像学结果与临床表现进行了关联分析。此外，还进行了免疫组化以确定某些生物标志物是否与影像学上的卒中有关。
纳入34例垂体腺瘤病例进行回顾性分析。在本研究中，影像学卒中定义为MRI上发现出血、梗死或囊肿的病例。急性临床表现定义为出现以下任何一种症状：严重突发头痛、视力下降和/或视野缺损以及急性精神状态改变。通过免疫组化检测胎儿肝激酶1（Flk-1）、神经纤毛蛋白（NRP）和血管内皮生长因子（VEGF）的表达来定量血管生成，同时使用内皮糖蛋白和CD31评估微血管密度（MVD）。
临床上，14例患者出现急性症状，20例患者有轻度或无临床症状。影像学上，15例患者符合影像学卒中标准。在15例影像学卒中患者中，9例出现急性症状，而在19例无影像学卒中的患者中，5例出现急性症状。在追踪的5种生物标志物中，仅发现VEGF与影像学和非影像学卒中均呈正相关。
虽然目前垂体卒中是在临床症状可通过组织学证实的情况下定义的，但我们认为，影像学上发现的垂体出血且症状轻微或无症状的病例应被指定为亚急性或亚临床卒中。VEGF被认为与垂体出血呈正相关。考虑到有症状或无症状垂体肿瘤出血的发生率较高，需要进一步研究以检测垂体出血的预测指标。
