Retrospective Study Of Diagnosis And Treatment Of Pituitary Apoplexy

BACKGROUND:Pituitary apoplexy(PA) is one of neurologic emergent conditions, it is a clinical syndrome caused of sudden hemorrhage or infarction of the pituitary tumors. The clinical features of pituitary apoplexy vary because of different amount of bleeding. Some patients display without any manifestations, and can not be diagnosed until CT or MRI. While others appeared disturbance of consciousness, coma and even death. Clinical symptomatic pituitary apoplexy is a well-described syndrome characterized by sudden headaches, visual impairment, hypopituitarism and, at times, impaired consciousness. Subclinical or silent pituitary apoplexy is characterized by atypical clinical manifestations and diagnosed by imaging or histopathology.Objective:Study the linical data of patients with pituitary apoplexy. The aim of this research is to evaluate the tumor size, clinical manifestation, pathologic types, postoperative symptoms improved and complications by contrast with the patient with non-stroke-related pituitary adenoma in the same period.Methods:We retrospectively identified 74 patients who was diagnosed by imaging or histopathology from January 2005 to January 2008 in Qilu hospital. Of these patients, 12 cases have typical clinical manifestations. We compared these patients with randomly 95 cases with non-stroke-related pituitary adenoma in the same period. RESULTS:We identified 74 patients (34 men,40 women; age range 25-67 years, meanage 48 years) who have pituitary hemorrhage. Of these patients,12 cases were diagnosed as clinical symptomatic pituitary apoplexy. While the randomly 95 patients (39 men, 56 women; age range 19-73 years, mean age 41 years) without hemorrhage or infarction were classified as non-stroke-related pituitary adenoma.1. Pituitary apoplexy and tumor sizeThe mean maximum diamete of patients with pituitary apoplexy is 3.19±1.01cm, and obviously higher than that with non-stroke-related pituitary adenoma.The difference is significant(P<0.05).2.Pituitary apoplexy and clinical manifestationsIn the group of pituitary apoplexy patients, vision disorder, visual field defect and sudden severe headache is the major clinical manifestations of pituitary apoplexy. Especially for the typical pituitary apoplexy, all appeared visual impairment and headache.3.Pituitary apoplexy and pathologic typeIn the group of 72 cases with pituitary apoplexy, The difference only in no functional pituitary adenoma is significant(P<0.05). While the others is not obvious difference(P>0.05).4.Pituitary apoplexy and Recovery of visionIn the group of patients with pituitary apoplexy,51 patients appeared vision impairment,45 cases in postoperative get different degree improvement.By statistical analysis, there is no obvious difference(P>0.05).5.Pituitary apoplexy and removal rateBy statistical comparison of total resection, most resection rate between pituitary apoplexy and non-stroke-related pituitary adenoma,there were no significant difference (P>0.05).6.Pituitary apoplexy and complicationsthere were no significant difference(P>0.05) in common complications after surgery through the contrast of pituitary apoplexy and non-stroke-related pituitary adenoma.Conclusion:1.Pituitary apoplexy take place relating to the tumor size and pathologic types.2.Vision disorder, visual field defect and sudden severe headache is the major clinical manifestations.3.Corticosteroids application and timely surgery is the important measures to save the vision and improve symptoms of patients.4.There were no significant difference in the visual acuity recovering, resection rate and complications with non-stroke-related pituitary adenoma.