Abstract:

Objective: To explore the pathogenesis, clinical manifestations, imaging and endocrine function characteristics, treatment methods, pathological characteristics and prognosis of pituitary adenoma apoplexy for ischemic infarction. Methods and Results: All 3 patients with pituitary adenoma apoplexy for ischemic infarction who were hospitalized in Affiliated Hospital of Hebei University from January 2021 to April 2022 were selected. All 3 patients presented with clinical manifestations such as headache, vision loss, cranial nerve palsy, and endocrine abnormalities. Preoperative endocrine examination indicated that one patient had decreased cortisol and prolactin levels. Preoperative MRI showed that all were large adenomas invading the cavernous sinus, hyperintensity on T₁WI and T₂WI, and uneven ring enhancement of the tumors. All 3 patients underwent endoscopic transsphenoidal resection of pituitary adenoma. Postoperative pathology confirmed pituitary adenoma with necrosis, all of which were coagulative necrosis. All 3 patients were finally diagnosed with pituitary adenoma apoplexy for ischemic infarction. Postoperatively, the clinical symptoms of all 3 patients improved significantly; one patient developed hypothyroidism and was treated with hormone supplementation. Conclusions: The clinical features of pituitary adenoma apoplexy for ischemic infarction are relatively typical. Multidisciplinary cooperation should be carried out, and the best treatment plan should be formulated based on the clinical characteristics of the patients.

Key words: Pituitary neoplasms, Adenoma, Ischemic stroke, Pituitary hormones, Magnetic resonance imaging, Pathology

摘要：

目的: 探讨梗死性垂体腺瘤卒中的发病机制、临床表现、影像学和内分泌功能特点、治疗方法、病理学特征及预后。方法与结果: 选择2021年1月至2022年4月河北大学附属医院收治的3例梗死性垂体腺瘤卒中患者，均存在头痛、视力下降、脑神经麻痹、内分泌异常等临床表现。术前内分泌检查提示1例出现皮质醇、催乳素水平降低。术前MRI显示均为侵袭海绵窦的大腺瘤，肿瘤T₁WI和T₂WI呈主体高信号，增强扫描可见不均匀环形强化。3例患者均采用神经内镜下经鼻蝶入路垂体腺瘤切除术，术后病理证实垂体腺瘤伴坏死且均为凝固性坏死。最终诊断为梗死性垂体腺瘤卒中。术后3例患者临床症状明显改善，1例出现甲状腺功能低下，给予药物补充激素。结论: 梗死性垂体腺瘤卒中临床特征较为典型，应多学科协作，根据患者临床特点制定最佳诊疗方案。

关键词: 垂体肿瘤, 腺瘤, 缺血性卒中, 垂体激素类, 磁共振成像, 病理学