Wu Fan, Huang Kaiyuan, Yang Jiqi, Zhang Luyuan, Zhang Chao, Zhan Renya, Pan Xinfa
Department of Neurosurgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China.
BMC Neurol. 2025 May 28;25(1):228. doi: 10.1186/s12883-025-04234-0.
Pituitary apoplexy is a clinical syndrome caused by hemorrhage or ischemia of a pituitary adenoma, typically presenting with sudden-onset headache, visual disturbances, and cranial nerve palsy. Pituitary apoplexy is relatively rare in clinical practice and is often triggered by an imbalance between the high metabolic demands of pituitary adenomas and their blood supply. Ischemic injury leads to pituitary cell necrosis, resulting in hypopituitarism, which can cause systemic multi-organ dysfunction and pose significant health risks.
We report the case of a 73-year-old male admitted with Escherichia coli sepsis and septic shock secondary to a urinary tract infection. The patient had a history of bladder cancer and undergone bladder tumor resection one month prior, followed by intravesical chemotherapy. After initial anti-infective and glucose-lowering therapy, his condition improved. However, on the fourth day of admission, he developed a sudden headache. Further investigations revealed a sellar mass and hypopituitarism. A retrospective review of his history indicated postoperative atrial flutter and vision loss three weeks prior to admission. Pituitary apoplexy was suspected, and following infection control, the patient underwent endoscopic transnasal surgery. Pathological examination confirmed a pituitary adenoma with extensive infarction. Postoperatively, the patient's vision improved, and he was discharged on the 25th day of hospitalization.
Pituitary apoplexy is a rare but potentially life-threatening condition that is often overlooked due to its nonspecific clinical manifestations. Diagnosing the condition is particularly challenging in the presence of concurrent severe infections. This case highlights the importance of carefully evaluating patients with postoperative headaches and vision changes. Cranial MRI and serum hormone testing should be considered to facilitate early diagnosis. Once confirmed, timely hormone replacement therapy and surgical intervention, when appropriate, can significantly improve patient outcomes.
垂体卒中是一种由垂体腺瘤出血或缺血引起的临床综合征，通常表现为突发头痛、视力障碍和颅神经麻痹。垂体卒中在临床实践中相对罕见，常由垂体腺瘤高代谢需求与其血供之间的失衡引发。缺血性损伤导致垂体细胞坏死，进而引起垂体功能减退，可导致全身多器官功能障碍并带来重大健康风险。
我们报告一例73岁男性患者，因尿路感染继发大肠杆菌败血症和感染性休克入院。该患者有膀胱癌病史，1个月前接受了膀胱肿瘤切除术，随后进行了膀胱内化疗。经过初始抗感染和降糖治疗后，他的病情有所改善。然而，入院第4天，他突然出现头痛。进一步检查发现蝶鞍区有肿物和垂体功能减退。回顾其病史显示，入院前3周有术后心房扑动和视力丧失。怀疑为垂体卒中，在控制感染后，患者接受了鼻内镜手术。病理检查证实为垂体腺瘤伴广泛梗死。术后，患者视力改善，住院第25天出院。
垂体卒中是一种罕见但可能危及生命的疾病，由于其非特异性临床表现常被忽视。在并发严重感染的情况下诊断该病尤其具有挑战性。本病例强调了仔细评估术后头痛和视力变化患者的重要性。应考虑进行头颅磁共振成像和血清激素检测以促进早期诊断。一旦确诊，及时进行激素替代治疗并在适当的时候进行手术干预，可显著改善患者的预后。
