梗死性垂体腺瘤卒中的临床分析

Clinical analysis of pituitary adenomas apoplexy for ischemic infarction

目的总结梗死性垂体腺瘤卒中的临床特点。方法回顾性分析9例缺血梗死性垂体腺瘤卒中的病例资料。8例有较典型的临床卒中症状。术前存在高生长激素血症6例,伴全垂体功能低下2例。CT或MRI增强扫描示肿瘤周边不均匀环形强化8例,鞍底下陷7例。术中见肿瘤血供差7例,明显干酪样或豆腐渣样组织5例,瘤内少量陈旧性出血2例。结果组织病理均见大片凝固性坏死,生长激素型腺瘤4例,生长激素+卵泡刺激素型腺瘤2例,催乳素型腺瘤1例,无功能型腺瘤2例。术后临床症状均不同程度改善,随访4个月以上,未见明显肿瘤残留或复发。结论梗死性垂体腺瘤卒中临床少见,常有较典型临床卒中症状,MRI表现具有特征性,生长激素型腺瘤具有好发倾向,经蝶入路手术治疗效果满意。

Objective To summary the clinical features of infarcted pituitary adenoma-associated apoplexy （IPAA） Methods Clinical data of 9 IPAA patients were analyzed retrospectively. The typical clinical stroke symptoms were found in 8 patients. Preoperative high serum growth hormone level existed in 6 patients and hypopituitarism in 2. The enhanced CT or MRI scan showed heterogenous ring enhancement in 8 patients and sellar floor depression in 7. During the surgery, poor tumor blood supply was found in 7 patients, caseous or bean-dregs like tissues in 5 and few dark blood clots in 2. Results Pathological examination showed massive coagulation necrosis in all the patients, and growth hormone adenoma in 4, growth hormone ＋ follicle stimulating hormone adenoma in 2, prolactin adenoma in 1 and non-functioning adenomas in 2. Symptoms were improved significantly and no recurrence was seen during follow-up more than 4 months. Conclusions IPAA is rare, often of typical symptoms and characteristic MRI, in which growth hormone pituitary adenomas maybe common and satisfactory recovery results from transsphenoidal surgery.