Acromegaly complicated with fulminant pituitary apoplexy: clinical characteristic analysis and review of literature,Endocrine

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Acromegaly complicated with fulminant pituitary apoplexy: clinical characteristic analysis and review of literature
Endocrine ( IF 3.0 ) Pub Date : 2023-05-17 , DOI: 10.1007/s12020-023-03379-7
Xue-Qing Zheng ₁ , Xiang Zhou ₁ , Yong Yao ₂ , Kan Deng ₂ , Hui You ₃ , Lian Duan ₁ , Hui-Juan Zhu ₁

Affiliation

Purpose

To retrospectively summarize the clinical features of acromegaly complicated with fulminant pituitary apoplexy and analyze the prognostic factors to guide early identification and timely treatment of such patients.

Methods

A retrospective analysis was carried out to summarize the clinical manifestations, hormone changes, imaging, treatment and follow-up of ten patients with acromegaly complicated with fulminant pituitary apoplexy admitted to our hospital from February 2013 to September 2021.

Results

The mean age of the ten patients (five males and five females) at the time of pituitary apoplexy was 37.1 ± 13.4 years old. There were nine cases with sudden severe headaches and five cases with visual impairment. All patients had pituitary macroadenomas, of which six cases with Knosp grade ≥3. The level of GH/IGF-1 hormone after pituitary apoplexy was lower compared with pre-apoplexy, and 1 patient reached biochemical remission spontaneously. Seven patients underwent transsphenoidal pituitary surgery after apoplexy and one patient was treated with long-acting somatostatin analog. The biochemical remission rate was 37.5% in eight patients immediately after treatment and 50% at the last follow-up. Patients with Knosp grade ≥3 were less likely to achieve biochemical remission than those with Knosp grade <3 (16.7% vs. 100%, p = 0.048), and patients who achieved biochemical remission had a smaller maximum tumor diameter [20.1 (20.1,28.0) mm vs. 44.0 (44.0,60) mm, p = 0.016].

Conclusion

Acromegaly complicated with fulminant pituitary apoplexy remains a diagnostic and therapeutic challenge.

中文翻译：

肢端肥大症并发暴发性垂体卒中的临床特点分析及文献复习

目的

回顾性总结肢端肥大症并发暴发性垂体卒中的临床特点，分析其预后因素，以指导该类患者的早期识别和及时治疗。

方法

回顾性分析我院2013年2月至2021年9月收治的10例肢端肥大症合并暴发性垂体卒中患者的临床表现、激素变化、影像学、治疗及随访情况。

结果

10 名垂体卒中患者（5 名男性和 5 名女性）的平均年龄为 37.1 ± 13.4 岁。突发剧烈头痛9例，视力障碍5例。所有患者均患有垂体大腺瘤，其中Knosp分级≥3级6例。垂体卒中后GH/IGF-1激素水平较卒中前降低，1例患者自发达到生化缓解。7 名患者在中风后接受了经蝶垂体手术，1 名患者接受了长效生长抑素类似物治疗。8 名患者治疗后即刻生化缓解率为 37.5%，末次随访时生化缓解率为 50%。Knosp 分级≥3 级的患者比Knosp 分级<3 级的患者实现生化缓解的可能性更小（16.7% vs. 100%，p = 0.048），并且实现生化缓解的患者的最大肿瘤直径更小[20.1（20.1， 28.0) 毫米与 44.0 (44.0,60) 毫米，p = 0.016]。