垂体卒中患者的临床特点和治疗效果观察：1项单中心回顾性研究

Clinical features and treatment outcomes of patients with pituitary apoplexy： a single-center retrospective study of 46 cases

摘要:

目的 探讨垂体卒中（pituitary apoplexy，PA）患者的症状、内分泌和影像学特点、临床转归及预后。方法 回顾性分析四川大学华西医院2015年1月1日—2021年12月31日期间诊断为“垂体卒中”患者资料。PA的诊断基于临床、影像学和病理组织学报告。总结其临床症状和体征、神经影像学、病理学和内分泌学结果，并分析临床转归及预后。结果 一共46名PA患者，其中20名男性（43.5%），平均年龄为47.05（15.81）岁，女性26名，平均年龄为31.96（14.78）岁。大多数人出现头痛（n=38，82.6%）和不同程度激素缺乏，其中最常见的垂体-性腺轴受累（28例，60.9%），其次是垂体-甲状腺轴受累（21例，45.7%）；垂体-肾上腺轴受累（19例，41.3%）；生长激素（growth hormone，GH）/胰岛素样生长因子-1（insulin-like growth factor 1，IGF-1）轴受累5例（10.9%）；垂体后叶受累（尿崩症）8例（17.4%）。所有垂体卒中患者都有核磁共振成像（magnetic resonance imaging，MRI）上的特征性改变，部分卒中患者的垂体MRI存在典型的液平。9例（19.6%）接受抗血栓治疗，12例接受手术治疗的患者随访中的7例存在垂体腺瘤复发，但无患者在急性病程中死亡。在随访期间（5.2±1.9）年，大部分患者存在垂体-靶腺激素低下，均予以激素替代治疗。结论 PA属于神经内分泌危急重症，症状早期认识和及时治疗，尤其是内分泌紊乱的纠正对于避免严重并发症至关重要。临床医师需要重视PA的垂体前叶功能减退，以避免潜在的风险。

Abstract:

Objective To investigate the clinical symptoms，endocrine and radiological features，clinical outcomes，and prognosis of patients with pituitary apoplexy.Methods A retrospective analysis was performed for the clinical data of 46 patients who were diagnosed with “pituitary apoplexy” in West China Hospital，Sichuan University，from January 1，2015 to December 31，2021，and the diagnosis of pituitary apoplexy was based on clinical，radiological，and histopathological reports. Clinical symptoms and signs，neuroimaging findings，pathological features，and endocrine results were summarized，and clinical outcome and prognosis were analyzed.Results A total of 46 patients with pituitary apoplexy were included，among whom there were 20 male patients（43.5%） with a mean age of 47.05（15.81） years and 26 female patients with a mean age of 31.96（14.78） years. Most patients had headache（n=38，82.6%） and varying degrees of hormone deficiency，among which pituitary-gonadal axis involvement was the most common type（n=28，60.9%），followed by pituitary-thyroid axis involvement in 21 patients（45.7%），pituitary-adrenal axis involvement in 19 patients（41.3%），GH/IGF-1 axis involvement in 5 patients（10.9%），and posterior pituitary involvement（diabetes insipidus） in 8 patients（17.4%）. All patients with pituitary apoplexy had characteristic changes on MRI，and some patients had the typical sign of liquefaction necrosis. Of all patients，9（19.6%） received antithrombotic therapy and 12 received surgical treatment，among whom 7 experienced the recurrence of pituitary adenoma during follow-up，while no patients died during the acute course of the disease. During follow-up for 5.2±1.9 years，most patients had hypopituitarism and received hormone replacement therapy.Conclusion Pituitary apoplexy is a critical neuroendocrine emergency，and early identification of symptoms and timely treatment，especially the correction of endocrine disorders，are of great importance for avoiding serious complications. Anterior hypopituitarism in pituitary apoplexy should be taken seriously by clinicians to avoid potential risks.