Extreme elevation of intrasellar pressure in patients with pituitary tumor apoplexy: Relation to pituitary function
Extreme elevation of intrasellar pressure in patients with pituitary tumor apoplexy: Relation to pituitary function
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DOI：
10.1210/jc.2004-0884
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发表时间：
2004-11-01
影响因子：
5.8
通讯作者：
Arafah, BM
中科院分区：
文献类型：
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作者：
Zayour, DH;Selman, WR;Arafah, BM
垂体大腺瘤患者中常见的垂体功能减退和高泌乳素血症的主要机制被认为是蝶鞍内腺瘤缓慢和逐渐扩张引起的鞍内压（ISP）增加。腺瘤出血性梗死（垂体瘤卒中）与鞍内内容物的快速而非渐进性增加有关。鞍内含量突然增加对ISP和垂体功能的影响尚不清楚。对13例发病1周内手术减压的垂体瘤卒中患者进行了ISP和垂体功能测定。ISP测量值非常高（中位数，47毫米汞柱），而血清催乳素（PRL）浓度普遍较低（中位数，3.5微克/升）。ISP值与血清PRL浓度呈负相关（r = -0.76; P < 0.01）。术后，13例患者中有7例垂体功能部分恢复或维持。这7名患者的血清PRL水平（9.3 +/- 7.4 μ g/L）和ISP测量值（35.9 +/- 7.3 mm Hg）低于（P < 0.001）其余6例持续性术后垂体功能减退症患者的相应值（分别为1.6 +/- 0.6 μ g/L和55.9 +/- 2.4 mm Hg）。肿瘤卒中患者血清PRL水平低提示ISP突然和极端升高导致垂体前叶缺血性坏死在这种情况下很常见。非PRL分泌型大腺瘤患者血清PRL水平正常或升高表明存在存活的垂体细胞，术后垂体功能恢复的可能性很高。
The dominant mechanism for hypopituitarism and hyperprolactinemia commonly observed in patients with pituitary macroadenomas was postulated to be increased intrasellar pressure (ISP) caused by the slow and gradual expansion of adenomas within the sella turcica. Hemorrhagic infarction of adenomas (pituitary tumor apoplexy) is associated with a rapid, rather than gradual, increase in intrasellar contents. The impacts of the sudden increase in intrasellar contents on ISP and pituitary function are unknown. ISP and pituitary function were determined in 13 patients with pituitary tumor apoplexy who had surgical decompression within 1 wk of symptoms' onset. ISP measurements were remarkably high (median, 47 mm Hg), whereas serum prolactin (PRL) concentrations were generally low (median, 3.5 mug/liter). There was an inverse correlation (r = -0.76; P < 0.01) between ISP measurements and serum PRL concentrations. Postoperatively, partial recovery or maintenance of pituitary function was noted in seven of 13 patients. These seven patients had higher (P = 0.013) serum PRL levels (9.3 +/- 7.4 mu g/liter) and lower (P < 0.001) ISP measurements (35.9 +/- 7.3 mm Hg) than the respective values in the remaining six with persistent postoperative hypopituitarism (1.6 +/- 0.6 mug/liter and 55.9 +/- 2.4 mm Hg, respectively). The low serum PRL levels in patients with tumor apoplexy suggested that ischemic necrosis of the anterior pituitary resulting from sudden and extreme elevation of ISP was commonly observed in this setting. A normal or elevated serum PRL level in patients with non-PRL-secreting macroadenomas indicates the presence of viable pituitary cells and the high likelihood of postoperative recovery of pituitary function.