垂体卒中：合并症、管理及预后——一项西班牙多中心观察性研究
Pituitary Apoplexy: Comorbidities, Management, and Outcomes-A Spanish Observational Multicenter Study.
作者信息
Biagetti Betina, Cordero Asanza Esteban, Pérez-López Carlos, Araujo-Castro Marta, Camara Rosa, Guerrero-Pérez Fernando, Vicente Almudena, Lamas Cristina, Serra Guillermo, Echarri Ana Irigaray, Ollero M Dolores, González Molero Inmaculada, Villar-Taibo Rocío, Moure Rodríguez María Dolores, García-Feijoo Pablo, Berrocal Víctor Rodríguez, Sánchez Ramirez María Noelia, Gutiéerrez Hurtado Alba, Capristan-Díaz Vanessa, Simó-Servat Andreu, Gallach Marta, Safont Perez Eva, González Rosa Victoria, Civantos Soralla, Asensio-Wandosell Diego, Martinez-Saez Elena, Menéndez Torre Edelmiro, Aulinas Anna, Iglesias Pedro, Diez Juan J, Bernabéu Ignacio, Álvarez-Escolá Cristina, Puig-Domingo Manel
机构信息
Endocrinology & Nutrition Department, Hospital Universitario Vall de Hebrón, CIBERER U747 (ISCIII), ENDO-ERN, Universitat Autónoma de Bracelona, Barcelona, PC 08032, Spain.
Neurosurgery Department, Hospital Universitario Vall de Hebrón, Departament de Cirurgia i Ciències Morfològiques, Universitat Autónoma de Barcelona, PC 08032, Spain.
出版信息
J Clin Endocrinol Metab. 2025 May 19;110(6):e1811-e1820. doi: 10.1210/clinem/dgae649.
BACKGROUND
Pituitary apoplexy (PA) is the paradigm of endocrine and neurosurgical emergency.
OBJECTIVE
To evaluate the comorbidities, risk factors, clinical presentation, pituitary apoplexy score (PAS), and the outcomes of surgical vs conservative management of PA in Spain.
METHODS
Spanish multicenter, observational study of 301 patients with acute PA. Statistical analyses compared risk factors, clinical presentation, and outcomes between surgical and conservative treatment groups, adjusting for potential confounders. The prevalence of cardiovascular risk factors in patients with PA was compared with the Spanish population and with patients with nonfunctioning pituitary adenomas.
RESULTS
Median age was 59.3 years, 201 (66.8%) were men; nonfunctioning adenomas (77.9%) were the most common tumor type. The prevalence of diabetes (20.3% vs 13.9%, P < .01), hypertension (48.8% vs 33.4%, P < .01), and dyslipidemia (44.2% vs 23.3%, P < .01), exceeded the Spanish age-adjusted population prevalence. Overall, 209 (69.4%) underwent surgery and 92 (30.6%) received conservative treatment. Surgical patients had larger tumors (26.2 vs 21.0 mm, P < .01), more frequent chiasmal compression (77.2% vs 53.4%, P < .01), and higher values of PAS. In the follow-up, although there were no statistically significant differences in anterior pituitary hormonal deficits between treatments, permanent vasopressin deficiency was more frequent after surgery (14.8% vs 3.3%, P < .01).
CONCLUSIONS
There is a high burden of cardiovascular risk factors among patients with PA, suggesting that metabolic factors may play a potential role in the development of PA. This underscores the need for comprehensive management of these conditions in addition to treating the apoplexy itself in this population. Surgical management has a relevant place in PA approach mainly in patients with higher PAS. However, it leads a permanent vasopressin deficit more frequently than a conservative approach.
背景
垂体卒中（PA）是内分泌和神经外科急症的典型病例。
目的
评估西班牙PA患者的合并症、危险因素、临床表现、垂体卒中评分（PAS）以及手术与保守治疗的结局。
方法
对301例急性PA患者进行西班牙多中心观察性研究。统计分析比较了手术组和保守治疗组之间的危险因素、临床表现和结局，并对潜在混杂因素进行了校正。将PA患者心血管危险因素的患病率与西班牙人群以及无功能垂体腺瘤患者进行比较。
结果
中位年龄为59.3岁，201例（66.8%）为男性；无功能腺瘤（77.9%）是最常见的肿瘤类型。糖尿病（20.3%对13.9%，P <.01）、高血压（48.8%对33.4%，P <.01）和血脂异常（44.2%对23.3%，P <.01）的患病率超过了西班牙年龄校正后的人群患病率。总体而言，209例（69.4%）接受了手术，92例（30.6%）接受了保守治疗。手术患者的肿瘤更大（26.2对21.0 mm，P <.01），视交叉受压更频繁（77.2%对53.4%，P <.01），PAS值更高。在随访中，尽管治疗之间垂体前叶激素缺乏无统计学显著差异，但手术后永久性血管加压素缺乏更常见（14.8%对3.3%，P <.01）。
结论
PA患者心血管危险因素负担较高，提示代谢因素可能在PA的发生中起潜在作用。这强调了在该人群中除治疗卒中本身外，还需要对这些情况进行综合管理。手术治疗在PA的治疗中占有重要地位，主要适用于PAS较高的患者。然而，与保守治疗相比，它导致永久性血管加压素缺乏的频率更高。
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