Differences In Clinical Features And Surgical Prognosis Of Two Types Of Pituitary Adenoma Stroke

Research backgroundPituitary adenoma(PA)originates from the anterior pituitary tissue and is one of the most common neuroendocrine tumors with the second highest incidence of primary intracranial tumors.Pituitary apoplexy is a series of clinical symptoms caused by increased pressure in the pituitary fossa caused by pituitary adenoma ischemia or bleeding,which oppresses the surrounding normal tissue.In this group of patients with pituitary adenomas,the incidence of pituitary apoplexy was2%-12%.At present,the pathogenesis of pituitary apoplexy is not clear,and most scholars believe that vascular mechanism is one of the important reasons for the occurrence and development of pituitary apoplexy.According to its characteristics,pituitary apoplexy can be divided into ischemic pituitary apoplexy and hemorrhagic pituitary apoplexy.After the occurrence of tumor stroke,the clinical symptoms are related to the physical signs and the characteristics of tumor growth,the compression of the tumor on the surrounding normal tissue and the type of stroke.Before the occurrence of tumor stroke,the clinical manifestations of some patients with pituitary adenomas are asymptomatic or mild and imperceptible,once the tumor stroke occurs,patients often have severe symptoms such as sudden headache,pituitary dysfunction,visual impairment(including complete blindness),cranial nerve paralysis and mental state changes,or even death.At present,the standard treatment of pituitary adenoma stroke is microsurgical resection and conservative treatment.Perioperative monitoring and evaluation of pituitary axis hormones,electrolytes and other related indicators,surgical resection of the tumor as soon as possible to achieve the purpose of decompression,so that the symptoms can be alleviated to the maximum extent.Research objectiveIn clinic,we have observed that pituitary adenoma ischemia and bleeding can cause a series of important clinical syndromes,and even some patients are life-threatening.However,there are few reports on the differences in clinical features and surgical outcomes between these two types of pituitary apoplexy.Therefore,it is very necessary to compare the clinical symptoms and surgical prognosis between ischemic pituitary apoplexy and hemorrhagic pituitary apoplexy.Research methodPatients with pituitary apoplexy who underwent surgery in the pituitary adenoma diagnosis and treatment center of our hospital from January 2013 to December 2018 were analyzed retrospectively.all these patients underwent transsphenoidal pituitary adenoma resection through microscope or neuroendoscope,and were followed up for at least one year to collect the clinical data of the subjects.The clinical features(sex,age,average tumor size,proportion of functional tumors,pituitary dysfunction,neuroendocrine symptoms,etc.),neuroimaging findings(sphenoid sinus mucosa thickening,pituitary ring sign)and surgical prognosis(postoperative cerebrospinal fluid leakage,intracranial infection,visual improvement,cranial nerve paralysis)were summarized and compared between the two groups.Research resultsAccording to the inclusion and exclusion criteria,a total of 67 patients were included,including 28 cases of ischemic pituitary apoplexy and 39 cases of hemorrhagic pituitary apoplexy.1.Compared with the hemorrhage group,there were more male patients in the ischemia group(78.6%vs53.8%,p=0.043).Compared with the ischemia group,the average age(51.4±2.0vs43.4±2.9),tumor size(2.8×2.9×2.1vs2.5×2.4×1.9)and the proportion of functional tumors(56.4%vs21.4%)were larger in the hemorrhage group.Compared with the bleeding group,headache symptoms(82.1%vs51.3%)were more common in the ischemia group.2.Referring to the patient’s magnetic resonance imaging data,it was found that sphenoid sinus mucosal thickening was observed in 15 patients with ischemic pituitary apoplexy(55.6%),but not in hemorrhagic pituitary apoplexy patients(n=38).It is worth noting that the incidence of preoperative pituitary dysfunction in patients with ischemic pituitary apoplexy(60.7%)seems to be higher than that in patients with hemorrhagic pituitary apoplexy(48.7%),but the difference is not statistically significant.3.The total tumor resection rates of the two groups were 94.1% and 92.9%,respectively.There was no significant difference in operation time,intraoperative blood loss and perioperative complications between the two groups.After operation,the cranial nerve symptoms of 81.8% of ischemic pituitary apoplexy patients and 82.6% of hemorrhagic pituitary apoplexy patients returned to normal.Importantly,the incidence of postoperative hypothyroidism decreased partially in both groups,and the incidence of hypothyroidism in patients with ischemic pituitary apoplexy decreased significantly from 46.4% to 18.5%(p=0.044).ConclusionPatients with ischemic pituitary apoplexy and hemorrhagic pituitary apoplexy show different clinical characteristics.For patients with preoperative neurological dysfunction,transsphenoidal resection of tumor should be considered first,which may be beneficial to the recovery of neurological and pituitary function.At the same time,surgical resection of the lesion is beneficial to the recovery of pituitary-thyroid axis function in patients with ischemic pituitary apoplexy.This study provides a new idea for the diagnosis and treatment of pituitary apoplexy.