Teasdale Stephanie, Hashem Fahid, Olson Sarah, Ong Benjamin, Inder Warrick J
Department of Diabetes and Endocrinology, Princess Alexandra Hospital , Brisbane, Queensland , Australia.
Department of Neurosurgery, Princess Alexandra Hospital , Brisbane, Queensland , Australia.
Endocrinol Diabetes Metab Case Rep. 2015;2015:140088. doi: 10.1530/EDM-14-0088. Epub 2015 Feb 1.
A case of recurrent pituitary apoplexy is described in a 72-year-old man who initially presented with haemorrhage in a non-functioning pituitary adenoma. Five years later, he re-presented with a severe pituitary haemorrhage in an enlarging sellar mass invading both cavernous sinuses causing epistaxis and bilateral ocular paresis. Subsequent histology was consistent with a sellar malignant spindle and round cell neoplasm. Multiple pituitary tumours have previously been reported to coexist in the same individual, but to our knowledge this is the only case where two pathologically distinct pituitary neoplasms have sequentially arisen in a single patient. This case is also notable with respect to the progressive ocular paresis, including bilateral abducens nerve palsies, and the presentation with epistaxis.
Ocular paresis in pituitary apoplexy can result from tumour infiltration of nerves, or by indirect compression via increased intrasellar pressure.Epistaxis is a very rare presentation of a pituitary lesion.Epistaxis more commonly occurs following trans-sphenoidal surgery, and can be delayed.
本文描述了一名72岁男性复发性垂体卒中病例，该患者最初表现为无功能垂体腺瘤出血。五年后，他再次出现严重的垂体出血，出血发生在一个扩大的鞍区肿物内，该肿物侵犯双侧海绵窦，导致鼻出血和双侧眼肌麻痹。后续组织学检查结果与鞍区恶性梭形和圆形细胞瘤一致。此前有报道称多个垂体肿瘤可在同一患者体内共存，但据我们所知，这是唯一一例在单一患者中先后出现两种病理特征不同的垂体肿瘤的病例。该病例在进行性眼肌麻痹方面也很值得关注，包括双侧展神经麻痹，以及鼻出血症状。
垂体卒中导致的眼肌麻痹可能是由于肿瘤浸润神经，或因鞍内压力升高间接压迫所致。鼻出血是垂体病变非常罕见的表现。鼻出血更常见于经蝶窦手术后，且可能延迟出现。
