Goyal Pradeep, Utz Michael, Gupta Nishant, Kumar Yogesh, Mangla Manisha, Gupta Sonali, Mangla Rajiv
Department of Radiology, St. Vincent's Medical Center, Bridgeport, CT, USA.
Department of Radiology, University of Rochester Medical Centre, Rochester, NY, USA.
Quant Imaging Med Surg. 2018 Mar;8(2):219-231. doi: 10.21037/qims.2018.03.08.
To discuss the clinical syndrome, review common imaging findings of pituitary apoplexy (PA) and role of imaging in therapy and follow-up. Also, to review other acute clinical scenarios with similar clinical and/or imaging findings as PA. PA is a severe and potentially life-threatening medical emergency, characterized by constellation of symptoms/signs that occur as a result of acute hemorrhage and/or infarction in pituitary gland. Patients present with acute and sudden onset of symptoms/signs, most commonly with severe headache, vision deficits/ophthalmoplegia, altered mental status, and possible pan hypopituitarism. Pre-existing macro adenoma (65-90%), especially non-functioning and prolactinomas, are most susceptible to apoplexy, which undergoes hemorrhage or infarct, but PA can occur with normal pituitary or microadenoma. Because of the probable grave prognosis of PA, imaging characteristics of PA and other acute clinical scenarios with similar clinical and/or imaging findings should be familiar to radiologists. PA is potentially a life-threatening clinical syndrome, however, imaging and clinical findings can lead the radiologist towards appropriate diagnosis, and rule out other clinical mimics. When hemorrhage is secondary to an underlying lesion, regrowth of the pituitary tumor years after a PA episode is possible and patients require long-term clinical and imaging surveillance.
讨论垂体卒中（PA）的临床综合征、回顾其常见影像学表现以及影像学在治疗和随访中的作用。此外，回顾其他具有与PA相似临床和/或影像学表现的急性临床情况。PA是一种严重且可能危及生命的医疗急症，其特征是由于垂体急性出血和/或梗死而出现的一系列症状/体征。患者表现为症状/体征急性突发，最常见的是严重头痛、视力障碍/眼肌麻痹、精神状态改变以及可能出现全垂体功能减退。先前存在的大腺瘤（65 - 90%），尤其是无功能腺瘤和催乳素瘤，最易发生卒中，即发生出血或梗死，但PA也可发生于正常垂体或微腺瘤。由于PA可能预后严重，放射科医生应熟悉PA以及其他具有相似临床和/或影像学表现的急性临床情况的影像学特征。PA可能是一种危及生命的临床综合征，然而，影像学和临床发现可引导放射科医生做出恰当诊断，并排除其他临床模拟情况。当出血继发于潜在病变时，PA发作数年之后垂体肿瘤有可能复发，患者需要长期的临床和影像学监测。
