Clinical Analysis Of Pituitary Apoplexy

Purpose:Pituitary apoplexy is sudden hemorrhage or infarction of pituitary adenoma due to headache, visual disturbance, ophthalmoplegia, altered mental status and a set of clinical syndrome. The disease was first discovered in 1898 by Bailey reported by Brougham in 1950 after a clinical summary and give a name. With the recent, modern scientific and technological progress to promote the rapid development of medical standards, in particular MRI, CT imaging and other advanced advent of many subclinical cases were found that subclinical pituitary apoplexy. Statistical difference incidence of pituitary apoplexy larger view by domestic and foreign literature, the incidence rate of about 4.4%-26.5%. The average age of onset about 50 years old. Pituitary macroadenoma or large proportion of adenomas than microadenomas stroke. A large number of domestic and foreign scholars through detailed studies of this illness, so that people more and more in-depth understanding of this disease, more extensive research, all research is also quite a lot of controversy. This study aimed to pituitary apoplexy on the clinical features, diagnosis, treatment and outcomes were analyzed and discussed.Methods:Retrospective analysis from August 2009 to December 2010 in Japan Union Hospital of Jilin University admitted 50 cases of pituitary adenoma, which was diagnosed 13 cases of pituitary tumor apoplexy. Patients before surgery, underwent head CT and endocrine hormones and/(or) MRI examination. Collect clinical data, clinical manifestations of these patients, clinical classification, imaging findings, predisposing factors, age, tumor size, hormone type, endocrine hormones, and other aspects of treatment and prognosis were analyzed. And further classification of patient age, tumor size, pathologic type and other factors were statistically analyzed using statistical software SPSS 13.0 Fisher exact test used for statistical analysis, P<0.05 was considered statistically significant.The results:In this study, patients with pituitary tumor apoplexy, headache, decreased visual acuity, visual field defect, a higher incidence of clinical symptoms. Subclinical pituitary apoplexy 84.62%. Patients with pituitary tumor apoplexy induced by many factors, and which accounted for no obvious incentive to 46.15%. Over 60 years of age in patients with pituitary tumor apoplexy pituitary tumor incidence rate was 71.43%. Pituitary adenoma pituitary apoplexy incidence rate of 35.0%, a huge pituitary adenoma pituitary apoplexy incidence rate of 55.56%. Nonfunctioning pituitary adenoma pituitary apoplexy incidence rate of 60.0%.Pituitary tumors in this group of stroke patients received comprehensive preoperative examination and preoperative preparations were given after the microsurgical transsphenoidal surgery, some patients auxiliary endoscope, in which emergency patients to the emergency operation, the other a more stable condition Also be given as soon as possible, postoperative complications are not serious. Hospital stay was 7 days-18 days, average length of stay 11.5 days.Improvement of symptoms after surgery:9 cases of vision loss in patients improved significantly after surgery in 7 cases, and recovered at discharge; 8 patients with visual field defects in 6 patients have different degrees of improvement after surgery; 3 cases of ophthalmoplegia in patients undergoing After the 2 patients improved significantly.1 case of sexual dysfunction in patients gradually returned to normal.1 case of menstrual disorders patients gradually returned to normal.2 cases of varying degrees of consciousness disorder patients were gradually recovered, returned to normal at discharge.1 case of diabetes insipidus and temperature changes, postoperative gradually returned to normal.2 cases of meningeal irritation symptoms of disease patients are gradually disappearing.2 cases of postoperative hospital stay after a transient diabetes insipidus; 7 cases of electrolyte imbalance, given the mediation after the return to normal levels and electrolyte balance.GOS score of patients given discharge showed:11 patients with good recovery (5 points); 2 patients had mild disability (4 points), mainly for poor visual acuity and visual field defects.Conclusion:1. This study shows atypical pituitary adenoma pituitary apoplexy stroke accounted for no small proportion of cases, but because of its typical clinical symptoms or no obvious clinical symptoms easily ignored or missed diagnosis, which is domestic and foreign scholars reported differences in the incidence of pituitary tumor apoplexy the larger one of the reasons.2. Pituitary apoplexy induced factors complex and varied, and a substantial proportion of patients with pituitary tumor apoplexy no obvious incentive, so the clinical work on patients with pituitary tumors should avoid the above triggers, and to further explore the pathogenesis of pituitary apoplexy mechanism for the occurrence of pituitary apoplexy to provide pre-sentence, and early treatment.3. Pituitary apoplexy in a higher incidence in people over 60 years of age, pituitary adenoma and giant pituitary adenomas higher risk of stroke, non-functional pituitary adenomas higher risk of pituitary tumor apoplexy.4. For each type of pituitary tumor apoplexy patients in the medical treatment given to the appropriate symptomatic stable disease as soon as possible after the granting of transsphenoidal microsurgical approach is more reasonable and effective treatment。The prognosis of pituitary apoplexy in patients with disease duration, disease severity and treatment when it is closely related in time properly。Therefore timely and effective treatment the prognosis of pituitary tumor apoplexy had significant help.