Lammert Alexander, Walter Marc Sebastian, Giordano Frank Anton, Al Zhgloul Mansour, Krämer Bernhard Karl, Nittka Stefanie, Schulte Dirk Michael, Ratliff Miriam, Hänggi Daniel, Seiz-Rosenhagen Marcel
Praxis für Diabetes, Stoffwechsel- und Nierenerkrankungen, Grünstadt, Germany.
5th Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany.
Exp Clin Endocrinol Diabetes. 2020 May;128(5):283-289. doi: 10.1055/a-0640-2915. Epub 2018 Jul 2.
Pituitary apoplexy is a serious medical complication of a pre-existing pituitary adenoma characterized by a variety of clinical symptoms ranging from mild headache to neurologically impaired and finally comatose patients. Management options are surgery or conservative treatment (e. g., with dexamethasone). Surgery is commonly performed in case of severe acute neurological and visual symptoms. However, prospective studies demonstrating a benefit of surgery over conservative treatment in terms of visual, neurological and even endocrine outcomes are lacking. Decision making is still controversial, and recommendations for surgery are based on low evidence grades and focus on visual impairment. Endocrine function and especially markers identifying patients with potential for pituitary recovery after surgery are not well described in the literature.
We analysed data from 24 patients (m:f/16:8) with a median age of 64 yrs (38 to 83yrs) that underwent surgery for pituitary apoplexy regardless of time from symptom onset. Apoplexies were necrotic in 14 cases and haemorrhagic in 10 cases.
Preoperatively, 7 patients (29.2%) showed complete anterior pituitary insufficiency, 16 patients (66.6%) had partial anterior pituitary insufficiency and one patient (4.17%) had normal pituitary functions. Persistent panhypopituitarism was found in 7 patients (29.2%), whereas an overall improvement of pituitary function was noted in 13 (57.1%) patients. Preoperative prolactin (PRL) levels were significantly associated with recovery of endocrine functions, whereas specifically all patients with preoperative PRL levels of at least 8.8 ng/ml recovered partially or fully. Time to surgery (0-7 days vs. 1-4 weeks vs.>4 weeks) was not significantly associated with outcome.
Our data emphasize that normal and high preoperative PRL levels are associated with better endocrine outcome after surgery. We conclude that patients benefit from surgical intervention even after delayed diagnosis with the serum PRL levels is being a valid biomarker for clinical decision making.
垂体卒中是一种已存在的垂体腺瘤的严重医学并发症，其特征是出现从轻度头痛到神经功能受损直至昏迷患者的各种临床症状。治疗选择包括手术或保守治疗（如使用地塞米松）。在出现严重急性神经和视觉症状时通常进行手术。然而，缺乏前瞻性研究来证明手术在视觉、神经甚至内分泌结果方面优于保守治疗。决策仍存在争议，手术建议基于低证据等级且侧重于视力损害。内分泌功能，尤其是识别术后有垂体恢复潜力患者的标志物，在文献中描述不足。
我们分析了24例患者（男:女/16:8）的数据，这些患者中位年龄为64岁（38至83岁），无论症状出现时间长短均接受了垂体卒中手术。14例卒中为坏死性，10例为出血性。
术前，7例患者（29.2%）表现为完全性垂体前叶功能减退，16例患者（66.6%）有部分垂体前叶功能减退，1例患者（4.17%）垂体功能正常。7例患者（29.2%）存在持续性全垂体功能减退，而13例（57.1%）患者垂体功能总体改善。术前催乳素（PRL）水平与内分泌功能恢复显著相关，具体而言，所有术前PRL水平至少为8.8 ng/ml的患者均部分或完全恢复。手术时间（0 - 7天 vs. 1 - 4周 vs. >4周）与结果无显著相关性。
我们的数据强调术前正常和高PRL水平与术后更好的内分泌结果相关。我们得出结论，即使在延迟诊断后，患者也能从手术干预中获益，血清PRL水平是临床决策的有效生物标志物。
