Agrawal Pankaj, Newbold Sally, Busaidi Ayisha Al, Kapoor Ritika R, Thomas Nick, Aylwin Simon Jb, Buchanan Charles R, Arya Ved Bhushan
Department of Paediatric Endocrinology, Variety Children Hospital, King's College Hospital NHS Foundation Trust, London, UK.
Department of Neuroradiology, King's College Hospital NHS Foundation Trust, London, UK.
Ann Pediatr Endocrinol Metab. 2022 Dec;27(4):320-324. doi: 10.6065/apem.2142204.102. Epub 2022 May 16.
Pituitary apoplexy typically presents with acute headache, vomiting, visual disturbance, and confusion. Herein, we report a rare presentation of ischemic stroke due to pituitary apoplexy. A 16.5-year-old male presented with reduced Glasgow Coma Scale (GCS) score, slurred speech, right-sided hemiparesis, and bitemporal hemianopia. Magnetic resonance imaging of the brain showed a large hemorrhagic sellar/suprasellar mass and an area of cortical T2/FLAIR hyperintensity with corresponding diffusion restriction in the middle cerebral artery territory. Computed tomography (CT) intracranial angiogram showed luminal occlusion of the clinoid and ophthalmic segments of both internal carotid arteries (ICAs, left>right) due to mass pressure effect. Biochemical investigations confirmed hyperprolactinemia and multiple pituitary hormone deficiencies. Stress-dose hydrocortisone was commenced with cabergoline, followed by urgent endoscopic transsphenoidal debulking of the tumor (subsequent histology showing prolactinoma). Postoperative CT angiogram showed improved caliber of ICAs. Intensive neurorehabilitation was implemented and resulted in complete recovery of motor and cognitive deficits. At the last assessment (18.8 years), the patient remained on complete anterior pituitary hormone replacement without cabergoline. Pituitary apoplexy is a medical emergency requiring prompt recognition and treatment and should be suspected in patients presenting with sudden, severe headache; nausea; or visual disturbance and meningism. Ischemic stroke is a rare manifestation of pituitary apoplexy in the pediatric population.
垂体卒中通常表现为急性头痛、呕吐、视力障碍和意识模糊。在此，我们报告一例因垂体卒中导致的缺血性卒中罕见病例。一名16.5岁男性，格拉斯哥昏迷量表（GCS）评分降低、言语含糊、右侧偏瘫和双颞侧偏盲。脑部磁共振成像显示鞍区/鞍上区有一个大的出血性肿块，大脑中动脉供血区皮质T2/液体衰减反转恢复序列（FLAIR）高信号，相应区域弥散受限。计算机断层扫描（CT）颅内血管造影显示，由于肿块压迫效应，双侧颈内动脉（ICA，左侧>右侧）床突段和眼段管腔闭塞。生化检查证实高催乳素血症和多种垂体激素缺乏。开始使用卡麦角林并给予应激剂量的氢化可的松，随后紧急进行内镜经蝶窦肿瘤减压（后续组织学检查显示为催乳素瘤）。术后CT血管造影显示颈内动脉管径改善。实施了强化神经康复治疗，运动和认知功能障碍完全恢复。在最后一次评估（18.8岁）时，患者仍在接受完全的垂体前叶激素替代治疗，未服用卡麦角林。垂体卒中是一种需要迅速识别和治疗的医疗急症，对于出现突发严重头痛、恶心或视力障碍以及脑膜刺激征的患者应怀疑此病。缺血性卒中是儿童垂体卒中的一种罕见表现。
