典型的垂体卒中(PA)是一种急性,由脑垂体的急性出血和/或梗塞引起的危及生命的临床综合征。PA被认为是神经内分泌紧急情况。然而,对于PA诊断和治疗的最佳选择尚无共识.
目的:根据现有的医学证据,为PA患者的诊断和治疗制定一项临床实践指南,以帮助参与护理的临床医生。
方法:以西班牙内分泌与营养学会(SEEN)神经内分泌学工作组2006年发布的垂体卒中临床诊疗指南和2011年发布的英国临床实践指南为依据。该文本已适应大多数国际医学期刊使用的格式。为此,在更新医学文献后,使用卫生保健政策和研究局(AHCPR)提出的系统评估了证据质量和建议的强度.
结论:对于有或没有神经眼科征象的急性重度头痛患者,应考虑垂体卒中的诊断。PA患者必须接受完整的病史和体格检查。所有怀疑垂体卒中的病人应紧急抽取血样检测电解质,肾功能,肝功能,凝固筛,全血细胞计数,垂体和外周激素的基础水平,并排除促肾上腺皮质激素(ACTH)缺乏。当患者临床稳定时,应进行正式的视野评估。磁共振成像(MRI)是确定诊断的首选影像学检查。PA患者的经验性紧急皮质类固醇治疗的适应症包括血流动力学不稳定,意识受损,视力下降,和严重的视野缺陷。在有这些严重神经眼科症状的患者中,应该考虑手术。手术应优选在症状发作后七天内进行。有轻度和稳定症状的患者可以通过仔细监测进行保守管理。PA患者的治疗和长期随访应由一个多学科小组进行,在其他人中,一位经验丰富的垂体神经外科医生,眼科医生,和内分泌学家.
Classic pituitary apoplexy (PA) is an acute, life-threatening clinical syndrome caused by acute hemorrhage and/or infarction of the pituitary gland. PA is considered a neuroendocrinological emergency. However, there is no
consensus about the best options for PA diagnosis and management.
OBJECTIVE: To develop a clinical practice
guideline with a number of recommendations for diagnosis and treatment of patients with PA based on the medical evidence available, in order to help clinicians involved in their care.
METHODS: The clinical
guideline for diagnosis and treatment of pituitary apoplexy issued in 2006 by the Neuroendocrinology Working Group of the Spanish Society of Endocrinology and Nutrition (SEEN) and the British Clinical Practice
Guideline published in 2011 were taken as the basis. The text has been adapted to the format used in most international medical journals. For this, after updated medical literature, the quality of evidence and the strength of the recommendations were evaluated using the system proposed by the Agency for Health Care Policy and Research (AHCPR).
CONCLUSIONS: Diagnosis of pituitary apoplexy should be considered in all patients with acute severe headache with or without neuro-ophthalmic signs. Patients with PA must undergo a complete history and physical examination. All patients with suspected pituitary apoplexy should have urgent blood samples drawn to test electrolytes, renal function, liver function, coagulation screen, complete blood count, and basal levels of pituitary and peripheral hormones, and to rule out adrenocorticotropic hormone (ACTH) deficiency. Formal visual field assessment should be performed when the patient is clinically stable. Magnetic resonance imaging (MRI) is the imaging test of choice to confirm diagnosis. Indications for empirical urgent corticosteroid therapy in patients with PA include hemodynamic instability, impaired consciousness, reduced visual acuity, and severe visual field defects. In patients with these severe neuro-ophthalmic signs, surgery should be considered. Surgery should preferably be performed within seven days of the onset of symptoms. Patients with mild and stable signs may be managed conservatively with careful monitoring. Treatment and long-term follow-up of patients with PA should be conducted by a multidisciplinary team consisting, amongst others, of an experienced pituitary neurosurgeon, an ophthalmologist, and an endocrinologist.