The Clinical Features, Diagnosis And Treatment Methods Of Acute Pituitary Apoplexy:the Case Reportand Literatures Review

OBJCTIVE:To investigate the clinical feature, diagnosis and treatment methods of acute pituitary tumor apoplexy.METHODS:Retrospective analysis of the clinical data in patient with acute pituitary tumor apoplexy, combined with literature review summary.MATERIAL:A 44-year-old male patient, decreased visual acuity with headache, nausea, vomiting three days.INTERVENIONS:The auxiliary examination laboratory and imaging (brain CT and pituitary MRI check) was implemented as soon as possible, in order to confirm the diagnosis, while correcting water, electrolyte disorder, high fever, and gives the substitutive therapy by related hormone. Trans-sphenoidal decompression operation was implemented under general anesthesia two days after admission when the general condition was improved. Postoperative patients should take long-term hormone substitutive therapy.RESULTS:The postoperative pathology examination showed pituitary apoplexy. Patients recovered well after operation and the visual acuity and pituitary function improved significantly.CONCLUSIONS:Acute pituitary apoplexy refers to pituitary apoplexy witch clinical symptoms peaked at 24h after rapid. The incidence of acute pituitary apoplexy rate is about 0.6%～10%. It is most common in 40 to 50 years. Acute pituitary tumor apoplexy is an acute clinical syndrome caused by sudden hemorrhaging, infarction of the pituitary gland, or hemorrhaging after infarction within a pituitary adenoma. It is a clinical syndrome included sudden headache, nausea and vomiting, visual deficit, oculomotor paresis and/or pituitary insufficiency, even an altered mental state, caused by the rapid enlargement of a pituitary tumor resulting in compression of surrounding structures. Although acute pituitary tumor apoplexy can be fatal through massive subarachnoid hemorrhage or secondary systemic complications, complete recovery is possible if therapeutic measures are initiated in time. Acute pituitary apoplexy is rare. Most pituitary adenomas apoplexy patients are caused by a giant pituitary adenoma or large adenoma. No functional adenoma is difficult to be found, is more likely to develop large adenoma or giant adenomas, which increases the risk of stroke hemorrhage. System application of anticoagulation, arteriosclerosis and hypertension, pituitary radio therapy, estrogen and application of bromocriptine are predisposing factors of acute pituitary apoplexy. CT is most useful in the acute setting, whereas MRI is the most ideal auxiliary examination means for diagnosis of acute pituitary apoplexy, because it is more useful for identifying blood components. For patients with acute pituitary apoplexy, especially for rapid deterioration of visual acuity or for altered consciousness, surgical decompression as soon as possible after restoration of the general condition provided the premise condition for the recovery visual acuity and pituitary function. Trans-sphenoidal approach is the preferred approach operation. Treatment of high fever, water and electrolyte balance disorder and hormone replacement therapy in perinatal operation period also played an important role in the prognosis of the patients. Most patients need long-term substitutive treatment by epinephrine, thyroxin, gonadal hormone or growth hormone.