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The results of pituitary function test at presentation wereavailable i The results of pituitary function test at presentation wereavailable i

The results of pituitary function test at presentation wereavailable i - PDF document

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The results of pituitary function test at presentation wereavailable i - PPT Presentation

ML Comm Table 7 Postsurgical endocrine outcomes of patients with apoplexy ZQFSQJUVJUBSJTNPSNBMx0001GVODUJPOZQPQJUVJUBSJTNx0001 35ZQFSQJUVJUBSJTNx0001 Ox001ex0013 x0012x0012 ID: 936266

x000e x0001 x0010 x0012 x0001 x000e x0012 x0010 x0013 patients x0016 pituitary x000c x0015 apoplexy x0014 x0027 ifbebdif x0011

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ML Comm The results of pituitary function test at presentation wereavailable in all patients. In considerable portion of apoplecticpatients (15 patients), preoperative assessments of pituitaryhormone were substituted by measurement of randomserum levels of hormone because the patients were neededurgent or early operation. Fourteen patients had clinicallynonfunctioning pituitary adenomas.Five patients showed deficiency of one ormore pituitary hormones; corticotrophindeficiency was found in 2, thyrotrophinin 1 and panhypopituitarism in 2. Ninepatients had normal pituitary functions,and increased somatomedinThe pituitary decompression via transsphenoidal approach was performedwithin 14 days after admission. Tumorcell type was defined by immunohistochemistry only in 9 of 16 cases, becausechanges. FSH was positive in 5 patients,GH in 2, TSH in 1, LH in 1, prolactinin 1 (Table 3).All patients with apoplexy underwentmagnetic resonance imaging (MRI) as aprimary investigation (Fig. 1). Thetumors were all macroadenomas, withan average size of 22.5 mm (Averageperpendicular diameters of the tumor on axial images, c :diameter on coronal or sagittal images). According to Hardyclassification, IIA and IIIA were the most common types(Table 4). Definitive hemorrhagic changes on MRI studywere found in 12 cases; early subacute stage of hemorrhagenecrotic degeneration of pituitary adenoma was in 4 (Table 5). On operation, hemorrhage with/without necrosis wasdetected in 6 cases (Fig. 2), necrosis with cystic fluid in 4 cases.However, there was no evidence of apoplexy except simpleliquified cystic

fluid in 6 cases (Table 5).The average length of follow5yr ) and there was no death. Thepatient̥s most recent clinical state at followand divided into the following group : no symptoms in 12disabling symptoms (requiring hormonalreplacement) in 4 patients. Visual acuity was assessed onfollow up period in 11 patients and was normal in 8, improvedbut not normal in 3. None was worse. Visual fields at followup were normal in all patients. Cranial nerve function returned Table 7. Postsurgical endocrine outcomes of patients with apoplexy )ZQFSQJUVJUBSJTN/PSNBMGVODUJPO)ZQPQJUVJUBSJTN )35)ZQFSQJUVJUBSJTN O /PSNBMGVODUJPO O   )ZQPQJUVJUBSJTN O   ABCD Fig. 2.tumor cell with coagulative necrosis and hemorrhage (H&E, J Korean Neurosurg Soc 42 Summary of 16 patients with pituitary apoplexy 1BUJFOU"HF ZS $IJFG1SFDJQJUBUJOH%FMBZUP7JTVBMTZNQUPNT&OEPDSJOFTUVEZ4FYDPNQMBJOUGBDUPSTTVSHFSZEFDSFBTFEGJFMEPDVMBS1SFPQ1PTUPQ BDVJUZEFGFDUQBMTZ.IFBEBDIFEOPSNBMOPSNBM.IFBEBDIFE$PSUJTPM1BOIZQPQJUVHEMVJUBSJTN'IFBEBDIFX  *** OPSNBM()

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1;OHNM.IFBEBDIFE   *** 7* *('*('OHNMOHNM 'IFBEBDIFE OPSNBMOPSNBM Summary of 16 patients with pituitary apoplexy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x

0001;**"IJHIMPXIFNPSSIBHJDOFDSPTJT **$IJHIIJHIIFNPSSIBHIJDOFDSPTJT the cavernous sinuses. In this study, all pituitary apoplexywas macroadenoma with an average size of 225 mm. EarlyThe two principles of management of pituitary apoplexyhave been transsphenoidal decompression and immediatedose corticosteroid replacement. Theredose corticosteroid replacementtherapy and careful management of fluid and electrolytebalance are mandatory. Randeva et al.strongly advocatesphenoidal surgery for pituitary apoplexy, withparticular urgency in patients with deteriorating vision.They argued that the procedure had a low morbidity andmortality and that they reliably reversed or improved theneuroophthalmological deficits and furthermore noted thatthis improvement was more likely in those patients operatedwithin 8 days (73%) compared with those operated on later(42%). Therefore, they thought that early but not emergencysurgery resulted in better outcome. Even late surgery forpituitary apoplexy was described as having satisfactory resultsin improved visual function.There has been a marked improvement in outcome inpituitary apoplexy over the past 30 years that reflects theprogress in surgical and endocrine management. The visualup period. In visual acuity,50% of patients was normal, 50% improved but not normaland in visual fields all were normalized which is similar to. Ocular paresis has a good prognosis withnormalization in 75%. Among five patients who hadhypopituitarism before operation, two restored in normalpitui

tary function and the remainder required replacementtherapy as in the previously published series. Diabetesinsipidus (DI) is much less common, probably because theblood supply of the posterior pituitary is different from thatof the anterior. There was no DI in this study. The overalloutcome was good, with 75% of patients alive with nosymptoms and 25% alive with minor nondisabled symptoms.The mortality was zero as a consequence of the apoplexy.Patients presenting with sudden headache, progressivevisual disturbance, altered consciousness should be highlysuspicious for pituitary apoplexy. An MRI scan is the imagingprocedure of choice. Early transsphenoidal decompressiondose corticosteroid replacement show good outcomeof pituitary apoplexy.1. Bills DC, Meyer FB, Laws ER Jr, Davis DH, Ebersold MJ, Scheithauer2. Biousse V, Newman NJ, Oyesiku NM : Precipitating factors in pituitary3. Cardoso ER, Peterson EW : Pituitary apoplexy : a review. 4. Ebersold MJ, Laws ER Jr, Scheithauer BW, Randall RV : Pituitary5. Kim JK, Park BJ, Cho KT, Lee SK, Cho MK, Kim YJ : Surgical6. Maccagnan P, Macedo CL, Kayath MJ, Nogueira RG, Abucham J :Conservative management of pituitary apoplexy : a prospective study.7. McFadzean RM, Doyle D, Rampling R, Teasdale E, Teasdale G :8. Milazzo S, Toussaint P, Proust F, Touzet G, Malthieu D : Ophthal9. Mohr G, Hardy J : Hemorrhage, necrosis, and apoplexy in pituitary12. Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass JA :Semple PL, Webb MK, de Villiers JC, Laws ER Jr : Pituitary apoplexy.14. Sibal L, Ball SG, Connolly V, James RA, Kane P, Kelly WF, et al