急性垂体瘤卒中的临床分析

目的 研究垂体卒中的发病机制、临床特点及最佳治疗方案.方法 回顾性分析37例垂体卒中患者的临床资料,按照治疗方法分为经蝶窦手术27例,经颅手术治疗10例,分别记录其临床表现、影像学检查、治疗方案和预后.结果 经蝶窦手术组,其中视力完全恢复17例,明显恢复7例,略恢复3例.10例术后发生垂体功能低下,其中6例需要长期激素替代疗法.经颅手术组,视力完全恢复3例,明显恢复3例,略恢复2例,视力障碍加重2例.8例术后出现垂体功能低下,其中5例需要长期激素替代治疗.结论 经蝶窦手术后视力改善明显优于开颅手术,并发垂体功能低下及尿崩的概率明显低于后者.尽早手术能有效逆转视力损害.     

亚临床垂体腺瘤卒中的诊断与治疗

目的：总结亚临床垂体腺瘤卒中的临床特点,探讨其诊断方法及手术疗效。方法：回顾性分析了1989年10月－2001年11月收治的21例亚临床垂体腺瘤卒中患者的临床表现和治疗情况。结果：这些患者的主要临床表现为慢性头痛、视力视野改变及垂体腺瘤体征,其中3例无任何临床症状。20例患者行显微手术治疗（其中急诊手术3例）,经口－鼻－蝶入路17例,经翼点入路3例;保守治疗1例。术前激素替代治疗12例。术后视力明显改善7例,部分改善8例,无变化4例,恶化1例。结论：亚临床垂体腺瘤卒中患者无典型临床表现,临床上易误诊而延误治疗。颅脑MRI检查是准确诊断垂体腺瘤卒中的最佳手段。经蝶手术安全有效,及时地激素替代疗法及早期手术是治疗患者严重视力障碍的有效方法。     

亚临床垂体腺瘤卒中的临床诊治

目的探讨亚临床垂体腺瘤卒中的临床特点、诊断和治疗。方法回顾性分析经手术治疗的130例亚临床垂体腺瘤卒中患者的临床资料。所有患者术前、术后均行内分泌激素及头颅CT和(或)MRI检查。结果经蝶入路手术89例,开颅手术41例,无手术死亡。泌乳素(PRL)腺瘤最多见(56．2％)。绝大多数为大或巨大垂体腺瘤(97％)。可能的诱发因素为高血压(6％)和糖尿病(4％)。术后随访时间平均为3．2年,肿瘤复发8例。术后12例放疗(4例残留,8例复发)。术后需要长期应用甲状腺激素、皮质类固醇激素及抗利尿激素进行替代治疗者分别为25％、20％和1％。结论亚临床垂体腺瘤卒中发生率较高。PRL腺瘤在亚临床垂体腺瘤卒中中最多见。MRI是亚临床垂体腺瘤卒中首选的检查方法。经蝶入路手术是治疗亚临床垂体腺瘤卒中安全有效的方法。亚临床垂体腺瘤卒中内分泌激素替代治疗率低,预后较好,术后放疗仅适用于肿瘤残留或复发者。     

垂体瘤卒中的诊疗6例病例分析

目的经过回顾性分析垂体瘤卒中患者的临床表现,探讨垂体瘤卒中的诊断及治疗策略。方法对6例经CT、MRI和病理检查确诊为垂体瘤卒中患者的临床特征进行分析,对疗效进行观察。结果 6例均经外科手术治疗,5例治愈,1例好转。结论垂体瘤卒中患者均应进行神经外科手术治疗以减低鞍内外压,防止误诊,完善检查是关键。     

暴发型垂体瘤卒中的诊断和治疗

目的阐明暴发型垂体瘤卒中患者的临床表现，探讨暴发型垂体瘤卒中的治疗方法。方法对7例经CT、MRI和病理检查确诊为暴发型垂体瘤卒中患者的临床特征进行分析，对疗效进行观察。结果7例均经外科手术治疗，6例好转，1例死亡。结论暴发型垂体瘤卒中患者，均应进行神经外科急症手术治疗以减低鞍内外压，以挽救生命及保存视力。积极防治术后并发症是降低患者术后死亡率的关键措施。     

经口鼻蝶入路显微切除垂体瘤术后窒息的原因分析及对策

目的探讨经口鼻蝶入路显微切除垂体瘤术后窒息的原因及处理对策。方法自1999年5月至2005年5月,采用经口鼻蝶入路显微切除垂体瘤328例发生术后窒息30例,对其发生原因及处理对策进行回顾性总结。结果328例垂体腺瘤行瘤体切除,术中顺利,术后进入监护室。术后发生窒息30例,窒息发生于术后6h的有15例,发生于6—24h的有8例,发生于24h后的有7例。30例经过气管插管救治均恢复平稳呼吸,痊愈出院。结论针对经口鼻蝶入路显微切除垂体瘤术后窒息发生的主要原因并提出防治措施。     

经额巨大垂体瘤显微外科全切除研究

报道２０例巨大垂体腺瘤经额～硬膜下入路在显微镜下全切除的研究。２０例中，男性９例，女性１１例。术后平均随访时间１３个月。结果：１８例视力障碍和１２例内分泌障碍得到改善，迄今无复发。应用显微外科技术对该肿瘤全切除可减少合并症和复发率。     

垂体功能性促性腺激素腺瘤临床病例分析

目的研究分析垂体功能性促性腺激素腺瘤女性患者的临床特征,以期达到早期诊断及治疗的目的。方法回顾性分析我院收治的5例垂体功能性促性腺激素腺瘤女性患者的临床特点及诊治经过。结果 5例患者均为生育年龄女性,平均年龄38.8岁,临床表现为月经紊乱、溢乳、头痛和视野缺损。盆腔超声发现双侧卵巢增大,内见多房囊性无回声。性激素检查雌激素4 377.65～12 973.45pmol/L,均值7 800.66pmol/L,而FSH和/或LH并未被异常升高的雌激素负反馈抑制,泌乳素(PRL)升高至1 268.18～2 794.16nmol/L,均值1 726.95nmol/L。垂体磁共振(MRI)检查发现垂体大腺瘤样改变。5例患者均接受垂体腺瘤切除术,病理切片免疫组化检查提示FSH/LH阳性,术后随访至今(3～5年)无肿瘤复发迹象。结论当绝经前女性出现月经紊乱、溢乳、头痛、视野缺损、反复发生的卵巢多房囊肿、雌激素异常升高的同时促性腺激素未被负反馈抑制时,应行垂体核磁共振检查,如发现垂体肿瘤,应考虑垂体功能性促性腺激素腺瘤的诊断。垂体瘤切除手术是首选治疗。     

垂体微腺瘤的诊断和治疗探讨

目的 探讨垂体微腺瘤（直径≤５ｍｍ）的诊断和治疗方法。方法 总结经ＣＴ垂体薄层扫描加矢,冠状重建诊断的垂体微腺瘤（直径≤５ｍｍ）２８例,全部采用经口鼻蝶窦入路显微手术切除。随访临床资料和内分泌改变,定期复查ＣＴ。结果 ２８例中病理证实２６例为垂体腺瘤,１例为炎症、１例为增生,诊断率达到９２．８％。汪变的术中定位成ＣＴ立体定位所见的位置完全符合。术后全部病例病情痊愈或好转,无手术死亡和并发症。２２例     

垂体泌乳素大腺瘤患者术后内分泌的变化及临床疗效分析

目的:探讨手术治疗垂体泌乳素大腺瘤的临床疗效,以及对机体内分泌的影响。方法:收集符合标准的患者45例,观察手术前后血清泌乳素(PRL)、雌二醇(E2)、促卵泡素(FSH)、黄体生成素(LH)、孕酮(P)和睾酮(T)等水平变化以及对应各种激素刺激后FSH、LH和睾酮(T)的变化,并对患者临床疗效进行评定。结果:患者术后3个月、6个月和1年进行临床疗效评价,有效率分别为37.78%、60.00%和75.56%;患者术后1年血清PRL水平与术前比较,显著下降。术前促卵泡素(FSH)、黄体生成素(LH)的水平分别为(10.52±8.17)和(6.28±4.74)mIU/mL,GnRH激素刺激后,LH水的峰值达到(12.34±1.78)(P<0.05),而FSH的最高峰值为(11.28±2.30)(P>0.05);术后LH和FSH与手术之前相比显著升高。睾酮(T)术前与术后的水平有统计学意义,但是hCG反应的峰值没有显著区别。结论:泌乳素大腺瘤通过下丘脑-垂体-性腺轴影响一系列促性腺激素的释放进而影响生殖器官的功能,手术治疗垂体泌乳素大腺瘤临床疗效确切,可以显著改善患者内分泌激素水平。     

An interesting case of a pituitary adenoma apoplexy mimicking an acute meningitis. Case report

Apoplexy of a pituitary adenoma is a rare and under-diagnosed clinical occurrence. It results from either infarction or haemorrhage into an adenoma of the pituitary gland. Its clinical presentation more often includes rapid development of impaired consciousness, severe headache, visual disturbance and variable association of oculomotor nerve palsy. Meningeal irritation signs are considered very rare and usually not reported as presenting symptoms. A 33-year-old male suffered a pituitary macroadenoma apoplexy, clinically indistinguishable from an infectious meningitis at presentation. Three days after surgery, the patient developed a left ophthalmoplegia due to 3(rd) nerve palsy, which fully resolved within 2 months. A right pterional craniotomy was performed during which complete tumour removal was achieved. In conclusion the authors believe that, despite many reports in the literature, encouraging conservative management in pituitary apoplexy by administering intravenous steroids, surgery should be undertaken in order to avoid eventual visual field defects, relieve pituitary gland compression and prevent a possible recurrent apoplectic episode or tumor re-growth.     

Isolated oculomotor nerve palsy following apoplexy of a pituitary adenoma.

An isolated oculomotor nerve palsy is very rarely the presenting sign of a pituitary adenoma. It may occur slowly due to mechanical compression or rapidly, secondary to pituitary apoplexy. Magnetic resonance imaging (MRI) with and without gadolinium DTPA enhancement provides excellent anatomical detail and is useful in the planning of the operative procedure. When correctly diagnosed and treated, the third nerve dysfunction appears to be reversible. We report a case of a pituitary adenoma presenting with an isolated, partial oculomotor nerve palsy in the setting of apoplexy. The pathophysiology, prognostic factors and MRI findings of this entity are discussed.     

Natural course of incidentally found nonfunctioning pituitary adenoma, with special reference to pituitary apoplexy during follow-up examination

OBJECT: The increase in the incidental detection of asymptomatic pituitary adenomas, known as "pituitary incidentalomas," led the authors to conduct a survey of the natural course of these lesions. METHODS: Forty-two patients with clinically nonfunctioning pituitary adenomas who had manifested no neurological or endocrinological disorders were monitored with magnetic resonance imaging studies. The follow-up period ranged from 10.8 to 168.2 months (mean +/- standard deviation, 61.9 +/- 38.2 months). The mean initial tumor size was 18.3 +/- 7 mm. In 21 patients, the tumor increased by at least 10% of its measured size on detection. This increase was first detected between 8.4 and 58.8 months (mean 31.8 +/- 17.6 months) after diagnosis. There was no correlation between the original tumor size, patient age, or the presence of intratumoral cysts and tumor growth. Symptoms were noted in 10 patients during follow up; in four, extensive tumor necrosis accompanied hemorrhage, leading to severe headache, acute ophthalmological symptoms, and panhypopituitarism, which was indicative of pituitary apoplexy. Transsphenoidal surgery was performed in 12 patients with enlarged tumors, including three with apoplexy. With the exception of one apoplectic patient, visual function was recovered in all who underwent surgery. All apoplectic patients continue to manifest hypopituitarism. CONCLUSIONS: In the course of 4 years, the size of the incidentalomas increased in 40% of 42 patients and became symptomatic in 20%. During the 5-year follow up, pituitary apoplexy developed in 9.5%. These findings may justify early intervention, especially in young individuals with incidentally found macroadenoma.     

Comparative analysis of pituitary adenoma with and without apoplexy in pediatric and adolescent patients: a clinical series of 80 patients

Neurosurgical Review - Pituitary adenomas (PAs) have a low incidence in pediatric and adolescent patients, and their clinical characteristics remain unclear. As a severe complication of PA,...     

Intraventricular hemorrhage from pituitary apoplexy

The case of a patient with a massive intraventricular hemorrhage arising from a pituitary chromophobe adenoma is described. This rare and disastrous complication was ascribed to the large suprasellar extension of the tumor and its close proximity to the floor of the third ventricle. Hemorrhage in the tumor extended along the path of least resistance and ruptured into the third ventricle. A partially treated hyperviscosity syndrome and chemotherapy for an unrelated malignancy (multiple myeloma) may have predisposed the patient to the necrosis and hemorrhage in the pituitary tumor.