Alam Sarah, Kubihal Suraj, Goyal Alpesh, Jyotsna Viveka P
Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India.
Ochsner J. 2021 Summer;21(2):194-199. doi: 10.31486/toj.20.0002.
Pituitary apoplexy results from hemorrhage, infarction, or hemorrhagic infarction within a pituitary tumor. Subclinical or clinical apoplexy is not uncommon in acromegaly, owing to the large size of the tumor at initial detection. Growth hormone excess in acromegaly often persists following surgery. However, in rare instances, pituitary apoplexy may present a spontaneous cure to growth hormone excess. A 40-year-old male presented with holocranial headache for the past 16 years that had worsened in severity during the prior year. Two months before presentation, he experienced a severe headache that he described as the worst headache of his life. The patient had prominent acromegaloid features that he ignored, as they seemed to cause no harm. The patient had no signs of clinically active disease. Magnetic resonance imaging of the brain revealed a pituitary macroadenoma with evidence of hemorrhage. Serum insulin-like growth factor 1 and oral glucose-suppressed serum growth hormone levels were normal, suggestive of inactive or silent disease. Pituitary apoplexy causing spontaneous remission of acromegaly was diagnosed, and close follow-up was planned for the evolution of hypopituitarism. This case highlights a rare presentation of acromegaly in which an episode of symptomatic pituitary apoplexy revealed the diagnosis of pituitary adenoma and led to the cure of growth hormone hypersecretion.
垂体卒中是由垂体肿瘤内出血、梗死或出血性梗死引起的。由于肢端肥大症患者最初检测时肿瘤体积较大，亚临床或临床垂体卒中并不少见。肢端肥大症患者术后生长激素分泌过多的情况往往持续存在。然而，在极少数情况下，垂体卒中可能会使生长激素分泌过多自行缓解。一名40岁男性，过去16年来一直患有全头痛，前一年头痛程度加重。就诊前两个月，他经历了一次严重头痛，他形容这是他一生中最严重的头痛。该患者有明显的肢端肥大样特征，但他并未在意，因为这些特征似乎并未造成伤害。该患者没有临床活动期疾病的迹象。脑部磁共振成像显示垂体大腺瘤并有出血迹象。血清胰岛素样生长因子1和口服葡萄糖抑制后的血清生长激素水平正常，提示疾病无活动或处于静止期。诊断为垂体卒中导致肢端肥大症自行缓解，并计划对垂体功能减退的进展进行密切随访。该病例突出了肢端肥大症的一种罕见表现，即有症状的垂体卒中发作揭示了垂体腺瘤的诊断，并导致生长激素分泌过多的治愈。
