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Journal of Neurosurgical Sciences 1999 March;43(1):25-36

lingua: Inglese

Pitui­tary apo­plexy. Clin­i­cal ­course, endo­crine eval­u­a­tions ­and treat­ment anal­y­sis

Casulari Roxo da Motta L. A., Andrade de Mello P., Moreira de Lacerda C., Pereira NEto A., Dominigues Casulari da Motta L., Farage Filho M.

Neu­ro­sur­gery ­Unit, Hos­pi­tal de ­Base do Dis­tri­to Fed­er­al (­UNC-­HBDF), Bra­sil­ia, Bra­sil


Background. ­The pur­pose ­was to ana­lyze clin­i­cal man­i­fes­ta­tions, hor­mo­nal chang­es, diag­no­sis dif­fi­cul­ties ­and treat­ment of pitui­tary apo­plexy (PA).
Experi­men­tal ­design. A ret­ro­spec­tive ­study of clin­i­cal ­records ­from ­patients ­with pitui­tary aden­o­mas admit­ted ­from Jan­u­ary 1980 to ­June 1996; ­the pur­pose ­was to iden­ti­fy ­the ­patients ­with clin­i­cal evi­dence com­pat­ible ­with PA. Set­ting. Neu­ro­sur­gery ­unit of an insti­tu­tion­al hos­pi­tal. ­Patients. Six­teen (12.8%) of 125 ­patients ­with pitui­tary aden­o­mas ­were ana­lyzed ­because ­they ­had pitui­tary apo­plexy. Inter­ven­tions. Sur­gi­cal treat­ment by ­the trans-­sphe­noid­al or trans­cra­ni­al ­route or ­both ­routes; dex­a­meth­a­sone (­DXM) treat­ment ­with 16 mg/­day i.v. Meas­ures. Hor­mone ­assays ­were per­formed ­either by radio­im­mu­noas­say or by chem­i­cal lumi­nes­cence.
­Results.­Tumors ­were non­func­tion­ing in ­nine ­patients ­and func­tion­ing in sev­en. ­TSH ­and pro­lac­tin ­basal ser­um lev­els ­were ­impaired in 55.5% ­and 10%, respec­tive­ly; ­after exog­e­nous ­TRH 80% of ­the ­patients ­did ­not ­show stim­u­la­tion of ­TSH ­and pro­lac­tin secre­tions. LH ­and ­FSH lev­els ­were ­low in 63.6% ­and 54.6% of ­the ­patients, respec­tive­ly; gon­a­dot­ro­phin-releas­ing hor­mone (­GnRH) test­ing ­was abnor­mal in 75% of ­the ­patients eval­u­at­ed. Cor­ti­sol lev­els ­were ­low in 50% of ­the ­patients. ­After insu­lin-­induced hypo­gly­ce­mia, cor­ti­sol ­and GH ­failed to ­rise in 25% ­and 40% of cas­es, respec­tive­ly. ­Ten ­patients ­were sub­mit­ted to sur­gi­cal treat­ment, ­but ­none dur­ing PA. ­The aver­age ­time ­from ­the ­onset of apo­plec­tic symp­toms ­and sur­gery ­was 70±50 ­days. ­Only ­one ­patient ­died ­two ­months ­after sur­gery. ­Five ­patients ­were treat­ed ­with dex­a­meth­a­sone (­DXM) dur­ing ­the apo­plec­tic symp­toms: ­three ­patients ­died; ­one ­patient ­had ­good qual­ity of ­life; ­the oth­er ­patient ­was treat­ed initial­ly ­with ­DXM ­with improve­ment of ­vision, ­but ­after sur­gery he devel­oped pan­hy­po­pit­uir­ar­ism. ­Two oth­er ­patients ­did ­not ­receive spe­cif­ic treat­ment ­for PA.
Con­clu­sions. PA is ­not a ­rare pitui­tary aden­o­ma com­pli­ca­tion ­and ­its prog­no­sis ­may be ­poor; base­line hor­mone lev­els ­showed a ­wide ­range of abnor­mal­ities of pitui­tary func­tion; sur­gi­cal treat­ment ­was ­required in ­the major­ity of ­patients ­and ­the prog­no­sis ­was rel­a­tive­ly ­good; on ­the con­trary, ­the treat­ment ­with ­DXM ­only ­had ­high lev­els of mor­tal­ity.

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