Clinical Study Of Pituitary Apoplexy

Objective:Pituitary apoplexy(PA) is a clinical syndrome which caused of hemorrhage or infarction of the pituitary tumors. The clinical manifestations and symptoms of pituitary apoplexy are complex and atypical. It was considered to be one of the rare emergent conditions with high mortality and morbidity. This research aims to analysis the clinical data and assist for diagnosis and treatment timely.Method:We retrospectively analysis the clinical data of patients who was diagnosed by imaging, surgery or histopathology between January2009to January2013in the First Affiliated Hospital of Guangxi Medical University, and People’s Hospital of Liuzhou.Result:We identified144patients(age ranged from17～70years) who have apoplexy, accounting for19.10%of pituitary tumors. Age group of40to59years old accounted for52.78%of all stroke patients. Clinical Pituitary Adenoma Apoplexy was34cases (4.51%, male to female ratio2.09:1), and Subclinical Pituitary Adenoma Apoplexy was110cases (14.59%, male to female ratio1.16:1).The age of onset in the clinical group and subclinical group were statistically significant (P=0.011<0.05). There was a significant difference (P=0.003<0.05) with age≥50years group and<50-year-old group. Pituitary apoplexy had many predisposing factors. Patients with hypertension (12.50%) and using Bromocriptine (5.56%) accounted for a larger proportion. Approximately71.53%of the patients had no obvious predisposing factors. The group of patients with vision loss101cases (70.14%), headache93cases (64.58%).There were34headache patients (100%),25with nausea, vomiting patients (73.53%) and21visual impairment patients (61.76%) in clinical group. The number of patients in clinical group who had eye muscle paralysis, unconsciousness, fever and meningeal irritation was more than subclinical group. The subclinical group had80visually impaired patients (72.73%),36visual field defects patients (32.73%) and59headache patients(53.64%).The original function manifestations of the pituitary adenoma are more commonly in the subclinical group which had21menopause lactation patients and14acromegaly patients.Patients after admission improve the inspection, fulminant acute stroke caught and given hormone replacement therapy, assess the patient’s condition and surgical indications, including five cases of conservative treatment,23cases craniotomy and116cases transsphenoidal approach surgery. Postoperative effects:There were15/21cases of the clinical group and65/80cases of subclinical group who had visual acuity improvement. Both of the groups had one case of postoperative deterioration of eyesight. There were16tumor resection cases,10subtotal resection cases,19postoperative diabetes insipidus cases and11electrolyte imbalance cases in clinical group. There were38tumor resection cases,54subtotal resection cases,48postoperative diabetes insipidus cases and19electrolyte imbalance cases in subclinical group.Conclusion:The occurrence of pituitary apoplexy was19.1%, it focused on in40-59year-old. The incidence of men was more than women.Pituitary tumor volume size affected the occurrence of apoplexy, whether it has invasive is one of the factors that affect of pituitary adenoma apoplexy occurs.The most common clinical manifestations of pituitary apoplexy were visual disturbances, headache and visual field defects. The clinical pituitary apoplexy all have headaches, nausea, vomiting and sudden changes in vision are also more common; The main performance of subclinical pituitary apoplexy was Visual impairment, but the symptoms are mild and easily missed. Pituitary apoplexy was more common in subclinical group.Cranial CT for early hemorrhagic pituitary apoplexy may have high-density performance. Brain MRI showed more sensitive within the tumor bleeding or infarct, but no abnormal change the head CT and MRI may still can’t rule out stroke, early determination of pituitary hormone level can assist in making the diagnosis.The application of glucocorticoid and timely surgery is the main treatment of pituitary adenoma apoplexy. For patients with subarachnoid hemorrhage, should be early surgery and adequate use of drugs to prevent vasospasm.