PDF(Pubmed)
Abstract：
Pituitary apoplexy (PA) is an acute, life-threatening clinical syndrome caused by hemorrhage and/or infarction of the pituitary gland. It is clinically characterized by the sudden onset of headache. Depending on the severity, it may also be accompanied by nausea, vomiting, visual disturbances, varying degrees of adenohypophyseal hormone deficiency, and decreased level of consciousness. Corticotropic axis involvement may result in severe hypotension and contribute to impaired level of consciousness. Precipitating factors are present in up to 30% of cases. PA may occur at any age and sometimes develops during pregnancy or the immediate postpartum period. PA occurs more frequently in men aged 50-60, being rare in children and adolescents. It can develop in healthy pituitary glands or those affected by inflammation, infection, or tumor. The main cause of PA is usually spontaneous hemorrhage or infarction of a pituitary adenoma (pituitary neuroendocrine tumor, PitNET). It is a medical emergency requiring immediate attention and, in many cases, urgent surgical intervention and long-term follow-up. Although the majority of patients (70%) require surgery, about one-third can be treated conservatively, mainly by monitoring fluid and electrolyte levels and using intravenous glucocorticoids. There are scoring systems for PA with implications for management and therapeutic outcomes that can help guide therapeutic decisions. Management of PA requires proper evaluation and long-term follow-up by a multidisciplinary team with expertise in pituitary pathology. The aim of the review is to summarize and update the most relevant aspects of the epidemiology, etiopathogenesis, pathophysiology, clinical presentation and clinical forms, diagnosis, therapeutic strategies, and prognosis of PA.
摘要：
垂体卒中（PA）是一种急性，由垂体出血和/或梗塞引起的危及生命的临床综合征。它的临床特征是突然发作的头痛。根据严重程度,也可能伴有恶心,呕吐,视觉障碍,不同程度的腺垂体激素缺乏，意识水平下降。促皮质轴受累可能导致严重低血压，并导致意识水平受损。在高达30%的病例中存在沉淀因素。PA可能发生在任何年龄，有时在怀孕期间或产后立即发展。PA在50-60岁的男性中更常见，在儿童和青少年中很少见。它可以在健康的垂体或受炎症影响的垂体中发展，感染,或肿瘤。PA的主要原因通常是垂体腺瘤（垂体神经内分泌肿瘤，PitNET）。这是一种需要立即注意的医疗紧急情况，在许多情况下,紧急手术干预和长期随访。尽管大多数患者（70％）需要手术，大约三分之一可以保守治疗，主要通过监测液体和电解质水平以及静脉使用糖皮质激素。PA的评分系统对管理和治疗结果具有影响，可以帮助指导治疗决策。PA的管理需要由具有垂体病理学专业知识的多学科团队进行适当的评估和长期随访。审查的目的是总结和更新流行病学最相关的方面，病因，病理生理学,临床表现和临床表现，诊断,治疗策略，和PA的预后。
