Kortbawi R, Ray A, Selman W R, Arafah B M
The Division of Endocrinology, University Hospitals/ Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, OH, USA.
The Department of Neurological Surgery, University Hospitals/ Cleveland Medical Center and Case Western Reserve University, Cleveland, Ohio, OH, USA.
Endocrine. 2025 Apr 14. doi: 10.1007/s12020-025-04222-x.
Pituitary tumor apoplexy [PTA] and Rathke's Cleft Cyst apoplexy (RCCA) are uncommon disorders causing hypopituitarism.
Examine the value of perioperative hormonal alterations in predicting recovery of impaired function in patients with PTA and RCCA.
Consecutive PTA (N = 97) and RCCA (N = 41) patients who had emergent surgery received dexamethasone until surgery. Perioperative HPA function and prolactin levels were frequently assessed while hydrocortisone therapy was provided to those exhibiting clinical or biochemical evidence [cortisol <10 ug/dL; <276 nmol/L] for insufficiency. Patients with multiple perioperative cortisol levels ≥15 ug/dL [414 nmol/L] were considered to have normal postoperative HPA function.
Patients with PTA were more likely to be males, older, have more severe hormonal deficits and worse visual impairment than those with RCCA. Impaired HPA function and lower prolactin levels were more prevalent in patients with PTA than in those with RCCA. Perioperative recovery of HPA function was demonstrated by a brisk increase in ACTH followed by a rise in two ACTH-dependent adrenal steroids: cortisol and DHEA-S in 23/59 [39%] patients with PTA and in 16/20 [80%] others with RCCA. The perioperative rise in ACTH was mirrored by a decline in prolactin levels. Patients recovering function had higher [P < 0.01] preoperative prolactin levels than those with persistent deficit. Follow up HPA testing confirmed perioperative assessment.
Perioperative measurements of ACTH and its dependent adrenal steroid levels accurately predict recovery of HPA function and support previously postulated role of increased intrasellar pressure and stalk compression in the pathogenesis of hypopituitarism in this setting.
垂体瘤卒中[PTA]和拉克氏囊肿卒中（RCCA）是导致垂体功能减退的罕见疾病。
研究围手术期激素变化对预测PTA和RCCA患者受损功能恢复的价值。
连续97例PTA患者和41例RCCA患者接受了急诊手术，术前均接受地塞米松治疗。围手术期频繁评估下丘脑-垂体-肾上腺（HPA）功能和催乳素水平，对出现临床或生化证据[皮质醇<10μg/dL；<276nmol/L]提示功能不全的患者给予氢化可的松治疗。围手术期多个皮质醇水平≥15μg/dL[414nmol/L]的患者被认为术后HPA功能正常。
与RCCA患者相比，PTA患者更可能为男性、年龄更大、激素缺乏更严重且视力损害更严重。PTA患者中HPA功能受损和催乳素水平较低比RCCA患者更普遍。23/59[39%]例PTA患者和16/20[80%]例其他RCCA患者围手术期HPA功能恢复表现为促肾上腺皮质激素（ACTH）迅速升高，随后两种ACTH依赖的肾上腺类固醇激素：皮质醇和硫酸脱氢表雄酮（DHEA-S）升高。围手术期ACTH升高的同时催乳素水平下降。功能恢复的患者术前催乳素水平高于持续存在功能缺陷的患者[P<0.01]。随访HPA检测证实了围手术期评估结果。
围手术期测量ACTH及其依赖的肾上腺类固醇激素水平可准确预测HPA功能恢复，并支持先前推测的鞍内压力升高和垂体柄受压在这种情况下垂体功能减退发病机制中的作用。
