亚临床型垂体腺瘤卒中的诊治

Diagnosis and treatment of subclinical pituitary adenoma apoplexy

目的总结203例亚临床型垂体腺瘤卒中患者临床特点、诊断、处理与结果。方法回顾性分析亚临床型垂体腺瘤卒中病人203例,149例行经鼻蝶垂体腺瘤切除术,54例行开颅切除手术。患者术前术后均作内分泌学检查,影像学检查为CT或MRI。结果所有病人视觉损害、头痛或垂体功能得到不同程度改善。泌乳素腺瘤是本组病例中最常见病理类型。大腺瘤及巨腺瘤患者容易发生亚临床型垂体腺瘤卒中。术后随访有24例垂体腺瘤复发。19例接受放疗。9例术后长期服用甲状腺素替代药物,8例服用类固醇激素。结论亚临床型垂体腺瘤卒中的发病率比急性卒中高。亚临床型垂体腺瘤卒中的发病机制尚不清楚。磁共振优于CT诊断亚临床型垂体腺瘤卒中。经鼻蝶手术治疗亚临床型垂体腺瘤卒中安全有效。

Objective To investigate the clinical features, diagnosis, treatment and outcomes of 203 consecutive patients with subclinical pituitary adenoma apoplexy. Methods The clinical data of 203 patients, in whom 149 underwent transsphenoidal surgery and 54 underwent transcranial surgery were analyzed retrospectively. Preoperative and postoperative endocrinological hormone concentrations were measured in all patients. Pituitary imaging was obtained by CT scans or MRI. Results Visual disturbance, headache and pituitary function impairment improved significantly in alX patients. Prolactinoma was the most frequent type of pituitary adenoma in our series. Subclinical pituitary adenoma apoplexy usually occurred in patients with large or giant adenomas. Postoperative follow-up showed the tumor recurred in 24 patients, 19 of whom were treated with postoperative radiotherapy. Long-term thyroid hormone replacement was necessary in 9 patients and steroid hormone replacement in 8. Conclusions The incidence of subclinical pituitary adenoma apoplexy is relatively higher compared with that of acute pituitary apoplexy. The exact pathogenic mechanism of subclinical pituitary adenoma apoplexy remains unknown. MRI is significantly better than CT scans for detection of subclinical pituitary adenoma apoplexy. Transsphenoidal decompression is safe and effective.