Background: Pituitary apoplexy is a potentially life-threatening condition that most often results from hemorrhage into a preexisting pituitary neuroendocrine tumor (PitNet) presenting with acute headache, visual impairment and endocrine dysfunction. Here, we aimed to identify factors associated with hemorrhage and present the pituitary hormonal status before and after transnasal-transsphenoidal tumor removal in a comparative study design. Methods: A series of 100 patients with PitNet were analyzed. We compared demographic data (age, sex, BMI), comorbidities, tumor volume and neuropathological findings between patients who presented with hemorrhagic PitNet (H-PitNet) and those with non-hemorrhagic PitNet (NH-PitNet). Furthermore, we compared the axis-specific hormonal status between both groups at admission and after microsurgical tumor removal and analyzed the overall endocrine outcome in both groups. Results: A total of 22 patients presented with hemorrhagic PitNet. There were no differences in age, sex, BMI, tumor volume, smoking status or diabetes status between patients with H-PitNet and those with NH-PitNet. H-PitNet was strongly associated with necrotic areas (p< 0.0001). Corticotropic PitNet was slightly overrepresented in H-PitNet (p= 0.04). Arterial hypertension was more frequent in patients with H-PitNet (p= 0.009). The presence of hypopituitarism in each axis at admission and after surgery was comparable between the two groups. In total, there were fewer recovering axes (p= 0.03) and more axes with persistent deficiency (p= 0.01) in the H-PitNet group after surgery. Conclusions: H-PitNet is associated with previous vascular event (ischemia or hemorrhage) and the presence of arterial hypertension and results in worse endocrine outcome. Early surgery should be considered in patients with PitNet and arterial hypertension.
背景：垂体卒中是一种可能危及生命的疾病，通常由已存在的垂体神经内分泌肿瘤（PitNet）内出血引起，表现为急性头痛、视力障碍和内分泌功能异常。本研究旨在通过比较性研究设计，识别与出血相关的因素，并呈现经鼻蝶入路肿瘤切除术前后的垂体激素状态。方法：对100例PitNet患者进行系列分析。我们比较了出血性PitNet（H-PitNet）与非出血性PitNet（NH-PitNet）患者的人口统计学数据（年龄、性别、BMI）、合并症、肿瘤体积及神经病理学发现。此外，我们比较了两组患者入院时及显微外科肿瘤切除术后各轴系激素状态，并分析了两组总体内分泌结局。结果：共22例患者表现为出血性PitNet。H-PitNet与NH-PitNet患者在年龄、性别、BMI、肿瘤体积、吸烟状况或糖尿病状况方面无显著差异。H-PitNet与坏死区域存在强相关性（p<0.0001）。促肾上腺皮质激素型PitNet在H-PitNet中比例略高（p=0.04）。H-PitNet患者中动脉高血压发生率更高（p=0.009）。两组在入院时及术后各轴系垂体功能减退的发生率具有可比性。总体而言，H-PitNet组术后激素轴恢复数量较少（p=0.03），而持续缺陷的激素轴数量更多（p=0.01）。结论：H-PitNet与既往血管事件（缺血或出血）及动脉高血压存在关联，并导致更差的内分泌结局。对于合并动脉高血压的PitNet患者，应考虑早期手术治疗。
肿瘤(癌症)患者之家