| Objective:To investigated the efficacy and safety of glucocorticoid replacement therapy in the treatment of pituitary apoplexy with normal serum cortisol level in 8:00 am before operation.Methods : Retrospective analysis 43 cases of patients with clinical pituitary adenomas patients who met the inclusion criteria from January 2007 to July2016 in our hospital department of Neurosurgery.Collected the clinical data,imaging data,pathological type,operation record and video of surgery,glucocorticoid replacement therapy,complication incidence after operation,according to whether used of glucocorticoid after admission divided into two groups,glucocorticoid replacement therapy group(observation group)and not used therapy group(control group),all patients underwent surgical treatment,Analysised the effect of surgical,pathological type,the levels of serum cortisol on third days and seventh day after operation,the occurrenceed of natremia and diabetes insipidus,analyzed the effect of emergency surgery and the efficacy and safety of glucocorticoid replacement therapy.Results:(1)There were 37 patients occurred dizziness and headache in all patients,accounted for 86.05%;29 cases occured blurred vision,accounted for67.44%;23 cases occured nausea and vomiting,accounted for 53.49%;5 casesoccured acute blindness,accounted for 11.62%,3 cases occured actation amenorrhea,accoutuned for 6.97%;2 cases occured acromegaly,accounting for4.65%;3 patients check stiff neck,gram positive sign,meningismus,accounted for about 6.97%;hemiplegia in 2 cases,accounted for 4.65%.(2)Among them,39 patients underwent transsphenoidal resection under microscope,4 cases underwent craniotomy,41 cases had total resection,the total resection rate was95.35%,2 cases had subtotal resection,and the subtotal resection rate was4.65%.18 cases in the observation group,17 cases had total resection,1 cases had subtotal resection,The control group has 25 patients,24 cases had total resection,1 cases had subtotal resection,p> 0.05,there was no statistic difference in two gruops.(3)The dizziness headache symptoms significantly compared with the preoperative remission in 33 patients,the observation group had 16 cases,the control group had 17 cases,There was no statistic difference in two groups.Two groups of patients with blurred vision,nausea and vomiting were relieved;5 cases of acute blindness,3cases of complete remission,2 cases improved significantly.(4)In postoperative pituitary prolactin in observation group was normal had 16 cases,lower than normal had 2 cases,18 cases of normal in control group,lower than normal had7 cases,p> 0.05,there was no statistic difference in two gruops;Growth hormone observation group was normal in 14 cases,lower than normal in 4cases,control group was normal in 19 cases,lower than normal in 6 cases,P >0.05,there was no statistic difference in two gruop.FT3 and FT4 observationgroup were normal in 16 cases,decreased in 2 cases,control group was normal in 14 cases,decreased in 11 cases,P > 0.05,the difference was not statistically significant.(5)Average postoperative hospital stay,the observation group(13.21+ 5.78)days,the control group(13.71 + 4.93)days,p> 0.05,the difference was not statistically significant.(6)The postoperative pathological results showed no functional adenoma in 19 cases,gonadotroph adenoma in 11 cases,pituitary adenoma in 5 cases(PRL),growth hormone(GH)and 3 cases of adenoma,3cases of mixed adenoma,1 cases of type ACTH and 1 cases of adenoma,TSH adenoma.(7)The serum cortisol levels of the two groups at third days after surgery was(13.89±6.53)ug/dl and(9.46±3.66)ug/dl,p<0.05,the difference was statistically significant;the serum cortisol levels of the two groups at seven days after surgery was(13.19±4.64)ug/dl and(8.78±2.20)ug/dl,p<0.05,the difference was statistically significant.(8)The postoperative cortisol was lower than 4ug/dl,the observation group was 0,the control group had 3 cases,p> 0.05,the was no difference statistically significant.(9)There was 3 cases had a transient diabetes insipidus in the observation group,and had 6 cases in the control group,p> 0.05,there was no difference statistically significant.(10)There was 3 cases occurred hyponatremia(less than 135mmol/L)in observation group,5 in the control group,p> 0.05,here was no difference statistically significant.(11)The levels of cortisol in the two groups were(9.01 + 4.51)ug/dl and(8.93 + 4.27)ug/dl in one month after surgery,p> 0.05,there was no difference statistically significant;The levels of cortisol in the two groups were(9.34±3.87)ug/dl and(8.72±4.09)ug/dl in three month after surgery,p> 0.05,there was no difference statistically significant.(12)There were 3 patients with cortisol lower than 4ug/dl after surgery,2 of them had gradual recovery of cortisol and no long-term replacement therapy.Only 1 patients were treated with oral hormone replacement therapy for a long time.Conclusion: 1.Glucocorticoid replacement therapy is only beneficial to maintain the serum cortisol level,but it has no obvious effect on postoperative recovery and prevention of postoperative complications.The preoperative clinical types of patients with pituitary apoplexy cortisol levels in the normal range without using glucocorticoid replacement therapy on the serum cortisol level closely monitoring the situation,but because of the small number of cases included in this study,the clinical individual differences in preoperative cortisol in the normal range of clinical use of patients with pituitary apoplexy glucocorticoid treatment remains to be further studied.2.After surgery,the residual pituitary gland function in patients with certain recovery,not using hormone replacement therapy,the function has not been restored,patients in the use of hormone replacement therapy premise,closely monitor the pituitary function.3.Clinical types of patients with pituitary apoplexy after admission to actively improve the preoperative examination,emergency surgical treatment to improve the clinical symptoms and signs were obvious patients,transsphenoidal sellar tumor resection of the total resection rate,lesspostoperative complications,less damage to patients,is the preferred surgical treatment.Pituitary apoplexy.4.The incidence of pituitary adenoma apoplexy,nonfunctional adenoma,gonadotropin adenoma,pituitary prolactin(PRL)adenoma,growth hormone adenoma(GH)> mixed adenoma > ACTH adenoma,TSH adenoma. |
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