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目的 对急性垂体卒中的临床表现、诱发因素、辅助检查、治疗和结果进行分析讨论。方法 回顾性分析1996年1月至2001年12月经手术治疗的35例急性垂体卒中病人。男17例,女18例。年龄19～69岁,平均46.5岁。所有患者术前、术后均行内分泌激素及头颅CT和/(或)MRI检查。结果 头痛是急性垂体卒中最常见的临床症状,其次是视觉障碍,再次为眼肌麻痹。急性垂体卒中的可能诱发因素为高血压、糖尿病。CT和MRI检查对急性垂体卒中确诊率分别为26%和90%。经蝶手术22例,开颅手术13例,无手术死亡。无功能性垂体腺瘤最多见,占65.7%。在急性垂体卒中后7天内手术,术后视力、视野改善率较高(P<0.05)。术后随访时间平均为3.2年,均恢复良好,肿瘤复发2例。术后4例放疗。术后长期需要甲状腺激素、皮质类固醇激素、睾酮和抗利尿激素替代治疗者分别为51%、56%、34%(男)、和3%。结论 突发头痛是急性垂体卒中最常见的症状。高血压和糖尿病是急性垂体卒中的重要诱发因素,无功能腺瘤在急性垂体卒中最多见。MRI是急性垂体卒中首选的检查方法。经蝶入路手术减压是治疗垂体卒中安全有效的方法。在垂体卒中后7d内手术视力、视野改善更明显。术后放疗仅适用于肿瘤残留或复发者。
Objective To analyze and discuss the clinical manifestations, predisposing factors, auxiliary examinations, treatments and results of acute pituitary apoplexy. Methods A retrospective analysis of 35 patients with acute pituitary apoplexy treated surgically from January 1996 to December 2001 was performed. 17 males and 18 females. Age 19 ~ 69 years old, average 46.5 years old. All patients underwent preoperative and postoperative endocrine hormones and cranial CT and / or MRI examination. Results Headache was the most common clinical symptom of acute pituitary apoplexy, followed by visual impairment and ophthalmoplegia again. The possible triggers for acute pituitary apoplexy are hypertension and diabetes. The diagnostic rates of CT and MRI in acute pituitary apoplexy were 26% and 90% respectively. 22 cases of transsphenoidal surgery, craniotomy in 13 cases, no operative death. Non-functional pituitary adenomas most common, accounting for 65.7%. Within 7 days after acute pituitary apoplexy, the improvement rate of postoperative visual acuity and visual field was higher (P <0.05). The mean duration of follow-up was 3.2 years, both of them recovered well and the tumor recurred in 2 cases. 4 cases after radiotherapy. Long-term need for thyroid hormone, corticosteroids, testosterone and antidiuretic hormone replacement therapy were 51%, 56%, 34% (male), and 3%. Conclusions Sudden headache is the most common symptom of acute pituitary apoplexy. Hypertension and diabetes mellitus are important inducing factors of acute pituitary apoplexy. Non-functional adenomas are the most common in acute pituitary apoplexy. MRI is the preferred method of examination for acute pituitary apoplexy. Transurethral decompression surgery is a safe and effective method of treatment of pituitary apoplexy. 7 days after pituitary surgery, visual acuity, visual field improvement more pronounced. Postoperative radiotherapy only applies to residual tumor or recurrence.