Artikel
Management and Follow-up of pituitary tumor apoplexy: a series of 27 patients
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Autoren
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G. Abi Lahoud
- Department of Neurosurgery, Roger Salengro Hospital, Lille, France
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B. Chevrier-Fraboulet
- Department of Neuroradiology, Roger Salengro Hospital, Lille
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R. Assaker
- Department of Neurosurgery, Roger Salengro Hospital, Lille, France
| Veröffentlicht: | 4. Mai 2005 |
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Gliederung
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Objective
The aim of this study is: 1- to stress on the necessity of rapid and correct diagnosis of pituitary apoplexy in order to decrease morbidity and mortality. 2- to insist on the role of a multidisciplinary management.
Methods
Retrospective study of 27 patients presenting with pituitary apoplexy: radiological, clinical and biological findings at initial presentation and at Follow-up.
Results
6 patients were known to harbour a pituitary adenoma. Radiological data showed intratumoral hemorrhage in 59% of cases, necrosis in 22% of cases and both in 19% of cases. Suprasellar extension was found in 100% of cases and laterosellar extension into cavernous sinus in 41%. Clinical presentation was one of an acute apoplexy in 74% of cases, sub-acute one in 19% of cases and silencious in the remaining 7% of cases. Clinical findings included headacke (81,5%), “chiasmatic syndrome” (74%), oculo-motor palsies (30%), alteration in consciousness (22%), nausea and vomiting (18,5%), and fever (15%). Pituitary insufficiency was found in 100% of cases. No patient presented with diabetes insipidus. Management of pituitary apoplexy was multimodal. 6 patients were treated symptomatically, 3 patients medically and 18 patients surgically. Mean Follow-up period was 30,5 months. In patients treated conservatively, MRI showed a significant decrease in tumor size and a pituitary scar between 6 and 12 months. Hypersecretion and MRI image normalized in 3 of the non-operated patients. At long term follow-up, thyreotrope deficit was noted in 61,5% of cases, corticotrope deficit in 55%, and gonadotrope deficit in 73%. The 5 cases of post-operative diabetes insipidus regressed completely. Oculo-motor palsies recuperated in all patients whatever treatment was. Favorable evolution of visual field was noted in 86,6% and of visual acuity in 87%.
Conclusions
Surgical treatment is indicated in patients with severe visual acuity loss (before day 7) or moderate visual acuity loss which didn’t recuperate within 2 weeks, in patients with oculo-motor palsies which didn’t respond to a minimum 3 weeks’ conservative treatment, in patients with severe non-remitting headacke, in case of diagnostic doubt. Conservative management has its place in the treatment of pituitary apoplexy, at least in the early stage when no severe visual loss is present and when the adenoma is somatotrope or lactotrope.
