Boyke Andre E, Michel Michelot, Mamelak Adam N
Department of Neurosurgery, Cedars-Sinai Medical Center, 127 S San Vicente Blvd, Los Angeles, CA, A6600, USA.
University of Florida College of Medicine, Gainesville, FL, USA.
Pituitary. 2024 Dec;27(6):898-908. doi: 10.1007/s11102-024-01420-0. Epub 2024 Aug 5.
Pituitary apoplexy (PA) is a clinical syndrome caused by acute hemorrhage and/or infarction of the pituitary gland, most commonly in the setting of a pituitary macroadenoma. PA generally presents with severe headache, nausea, vomiting, visual disturbance, and, in more severe cases, altered mental status. Many factors have been attributed to the risk of developing PA, including most recently, numerous reports showcasing an association with COVID-19 infection or vaccination. Initial management of PA includes evaluation and correction of deficient hormones and electrolytes and an assessment if surgical decompression to relieve pressure on optic nerves and other brain structures is needed. While prompt recognition and treatment are crucial to avoid morbidity and mortality, in the modern era, PA is less commonly considered a true neurosurgical emergency requiring immediate (< 24 h) surgical decompression. Traditionally, surgical decompression has been the standard of care for significant mass effects. However, several studies have shown similar outcomes in visual and hormonal recovery with either surgical decompression or conservative medical management. Unfortunately, most evidence on optimal management strategies is limited to retrospective case series, small prospective studies, and one multi-center observational study. This review aims to provide the most up-to-date evidence on the role of COVID-19 in PA and best management strategies.
垂体卒中（PA）是一种由垂体急性出血和/或梗死引起的临床综合征，最常见于垂体大腺瘤的情况下。PA通常表现为严重头痛、恶心、呕吐、视觉障碍，在更严重的情况下，会出现精神状态改变。许多因素被认为与发生PA的风险有关，包括最近大量报告显示与COVID-19感染或疫苗接种有关。PA的初始治疗包括评估和纠正激素和电解质缺乏，并评估是否需要进行手术减压以减轻对视神经和其他脑结构的压力。虽然及时识别和治疗对于避免发病率和死亡率至关重要，但在现代，PA较少被视为需要立即（<24小时）进行手术减压的真正神经外科急症。传统上，手术减压一直是治疗明显占位效应的标准方法。然而，几项研究表明，手术减压或保守药物治疗在视觉和激素恢复方面的结果相似。不幸的是，关于最佳管理策略的大多数证据仅限于回顾性病例系列、小型前瞻性研究和一项多中心观察性研究。本综述旨在提供关于COVID-19在PA中的作用和最佳管理策略的最新证据。
