Apoplexia hipofisária intradenomatosa

Rodrigues, Flávio Freinkel; Violante, Alice Helena Dutra; Andraus, Cesar Fantezia

doi:10.1590/S0004-282X1997000500020

Resumos

Os autores analisam a literatura sobre apoplexia hipofisária intradenomatosa, enfocando a fisiopatologia, o diagnóstico e a conduta terapêutica. Estudam 5 casos , de uma série de 86 pacientes com tumores hipofisários que desenvolveram esta síndrome e que foram diagnosticados e acompanhados pelos serviços de Neurocirurgia e Endocrinologia do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro. Todos os casos, a partir da suspeita clínica, tiveram o diagnóstico confirmado por estudo de tomografia computadorizada de crânio e/ou ressonância magnética de crânio. O tratamento de escolha foi cirúrgico. As conclusões apontam para as dificuldades diagnósticas desta situação clínica e da urgência na instituição da terapia.

apoplexia hipofisária; tumores hipofisários; perda visual

The authors review the literature on intra-adenomatous pituitary apoplexy with special emphasis on pathophysiology, diagnosis and therapeutic approach. They present five cases, from a series of 86 patients with pituitary tumors, that developed this syndrome. The patients were diagnosed and followed by the Neurosurgery and Endocrinology Services of Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro. Diagnosis was confirmed by CT-Scan and MRI in all cases , and the treatment of choice was surgical. Conclusions point to the diagnostic difficulties and the urgency of treatment in this clincal setting.

pituitary apoplexy; putuitary tumors; visual impairment

Apoplexia hipofisária intradenomatosa

Intra-adenomatous pituitary apoplexy

Flávio Freinkel Rodrigues^I; Alice Helena Dutra Violante^II; Cesar Fantezia Andraus^III

^IHospital Universitário Clementino Fraga Filho (HUCFF) da Universidade Federal do Rio de Janeiro (UFRJ): Chefe do Serviço de Neurocirurgia do HUCFF da UFRJ, Professor Adjunto Doutor de Neurocirurgia da Faculdade de Medicina da UFRJ, Coordenador do Curso de Pós-Graduação em Neurocirurgia da UFRJ

^IIHospital Universitário Clementino Fraga Filho (HUCFF) da Universidade Federal do Rio de Janeiro (UFRJ): Professora Adjunta Doutora de Endocrinologia da Faculdade de Medicina da UFRJ

^IIIHospital Universitário Clementino Fraga Filho (HUCFF) da Universidade Federal do Rio de Janeiro (UFRJ): Mestrando em Neurocirurgia da UFRJ, Médico Neurocirurgião do HUCFF da UFRJ

RESUMO

Os autores analisam a literatura sobre apoplexia hipofisária intradenomatosa, enfocando a fisiopatologia, o diagnóstico e a conduta terapêutica. Estudam 5 casos , de uma série de 86 pacientes com tumores hipofisários que desenvolveram esta síndrome e que foram diagnosticados e acompanhados pelos serviços de Neurocirurgia e Endocrinologia do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro. Todos os casos, a partir da suspeita clínica, tiveram o diagnóstico confirmado por estudo de tomografia computadorizada de crânio e/ou ressonância magnética de crânio. O tratamento de escolha foi cirúrgico. As conclusões apontam para as dificuldades diagnósticas desta situação clínica e da urgência na instituição da terapia.

Palavras - chave: apoplexia hipofisária, tumores hipofisários, perda visual.

ABSTRACT

The authors review the literature on intra-adenomatous pituitary apoplexy with special emphasis on pathophysiology, diagnosis and therapeutic approach. They present five cases, from a series of 86 patients with pituitary tumors, that developed this syndrome. The patients were diagnosed and followed by the Neurosurgery and Endocrinology Services of Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro. Diagnosis was confirmed by CT-Scan and MRI in all cases , and the treatment of choice was surgical. Conclusions point to the diagnostic difficulties and the urgency of treatment in this clincal setting.

Key words: pituitary apoplexy, putuitary tumors, visual impairment.

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Full text available only in PDF format.

Aceite: 26-agosto-1997.

Dr. Flávio Freinkel Rodrigues - Rua Professor Álvaro Rodrigues 255 apto 101 - 22 280-040 Rio de Janeiro RJ - Brasil

1. Arnold AC. Neuroophthalmologic evaluation of pituitary disorders. In: Melmed S (ed). The pituitary. New York: Blackwell, 1995:687-707.
2. Bakheit O, Magid A, Kennedy PGE. Unusual presentation of a large pituitary tumours in relation to diving. Post Grad Med J 1989:65;27-30.
3. Bernstein M, Gentili F, Brothers M, Holgate R, Sturtridge WC, Deck J. Pituitary apoplexy associated with a triple bolus test: case report. J Neurosurg 1984;61:586-590.
4. Brougham M, Heusner AP, Addams S. Acute degenerative changes in adenomas of the pituitary body with special reference to pituitary apoplexy. J Neurosurg 1950;7:421-439.
5. Cardoso ER, Peterson EW. Pituitary apoplexy: a review. Neurosurgery 1984;14:363-373.
6. Chapman AJ, Williams G, Hockley AD, London DR. Pituitary apoplexy after combined test anterior pituitary function. Br Med J 1985;26:291-295.
7. Conomy JP, Ferguson JH, Brodkey JS, Mitsumoto H. Spontaneous infarction in pituitary tumors: neurologic and therapeutic aspects. Neurology 1975;25:580-587.
8. David M, Philippon J, Navarro-Artiles F, Racadot J, Weil BB.Les formes hémorragiques des adénomes hypophysaires: aspects cliniques et etiologiques. Neurochirurgie 1969;15:228-229.
9. Donovan PMJ, David NJ, Glaser JS, Safran A. Pituitary apoplexy: diagnosis by computed tomography. Radiology 1980;134:665-670.
10. Ebersold M, Laws ER, Scheithauer BW, Randall RV. Pituitary apoplexy treated by transphenoidal surgery. J Neurosurg 1983;58:315-320.
11. Gorczyca W, Hardy J. Arterial supply of the human anterior pituitary gland. Neurosurgery 1987;20:369-378.
12. Holness RO, Ogundimu FA, Langille RA. Pituitary apoplexy following closed head trauma. J Neurosurg 1983;59:677-679.
13. Leclerc F, Grisoli F. Arterial blood supply of the normal pituitary gland. J Neurosurg 1983;58:678-681.
14. L'Huillier F, Combed C, Martin N, Leclerc X, Pruvo JP, Gaston A. Apport de I'IRM dans les adénomes hypophysaires à révélation aigüé: à propos de 7 observations. J Neuroradiol 1989;16:221-237.
15. Maccagnan P, Macedo CLD, Kayeth MJ et al. Conservative management of pituitary apoplexy: a prospective study. J Clin Endocrinol Metab 1995;80:2190-2197.
16. Mc Fadzen RM, Doyle D, Rampling R, Teasdale E, Teasdale G. Pituitary apoplexy and its effect on vision. Neurosurgery 1991;29:669-675.
17. Mohr G, Hardy J. Hemorrhage, necrosis and apoplexy in pituitary adenomas. Surg Neurol 1982;18:181-189.
18. Nourizadeh AR, Pitts FW. Hemorrhage into pituitary adenoma during anticoagulant therapy. JAMA 1965;193:623-625.
19. Poisson M, Van Effentere R, Mashaly R. Pituitary apoplexy with rectraction nistagnus. Ann Neurol 1980;7:286-325.
20. Proust F, Hanneguim D, Bellow F. et al. Apoplexie pituitaire a l'effort en deux temps. Neurochirurgie 1995;5:372-376.
21. Rovit RL, Fein JM. Pituitary apoplexy: a review and reappraisal. J Neurosurg 1972;37:280-288.
22. Stanfield JP. The blood supply of the human pituitary gland. J Anat 1960;94:257-273.
23. Sussman EB, Porro RS. Pituitary apoplexy: the role of atheromatous emboli. Stroke 1974;5:318-323.
24. Wakai S, Fukushima T, Teramoto A, Sano K. Pituitary apoplexy: its incidence and clinical significance. J Neurosurg 1981;55:187-193.
25. Weisberg LA. Pituitary apoplexy: association of degenerative change in pituitary adenoma with radiotherapy and detection by cerebral computed tomography. Am J Med 1977;63:109-115.
26. Wright RL, Ojemann RG, Drew JH. Hemorrhage into pituitary adenoma. Arch Neurol 1965;12:326-331.
27. Yamaji T, Ishibashi M, Kosaka K. et al. Pituitary apoplexy in acromegaly during bromocriptine therapy. Acta Endocrinol 1981:98:171-177.

Datas de Publicação

Publicação nesta coleção
07 Out 2010
Data do Fascículo
1997

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Arnold AC. Neuroophthalmologic evaluation of pituitary disorders. In: Melmed S (ed). The pituitary. New York: Blackwell, 1995:687-707.

[2] 2. Bakheit O, Magid A, Kennedy PGE. Unusual presentation of a large pituitary tumours in relation to diving. Post Grad Med J 1989:65;27-30.

[3] 3. Bernstein M, Gentili F, Brothers M, Holgate R, Sturtridge WC, Deck J. Pituitary apoplexy associated with a triple bolus test: case report. J Neurosurg 1984;61:586-590.

[4] 4. Brougham M, Heusner AP, Addams S. Acute degenerative changes in adenomas of the pituitary body with special reference to pituitary apoplexy. J Neurosurg 1950;7:421-439.

[5] 5. Cardoso ER, Peterson EW. Pituitary apoplexy: a review. Neurosurgery 1984;14:363-373.

[6] 6. Chapman AJ, Williams G, Hockley AD, London DR. Pituitary apoplexy after combined test anterior pituitary function. Br Med J 1985;26:291-295.

[7] 7. Conomy JP, Ferguson JH, Brodkey JS, Mitsumoto H. Spontaneous infarction in pituitary tumors: neurologic and therapeutic aspects. Neurology 1975;25:580-587.

[8] 8. David M, Philippon J, Navarro-Artiles F, Racadot J, Weil BB.Les formes hémorragiques des adénomes hypophysaires: aspects cliniques et etiologiques. Neurochirurgie 1969;15:228-229.

[9] 9. Donovan PMJ, David NJ, Glaser JS, Safran A. Pituitary apoplexy: diagnosis by computed tomography. Radiology 1980;134:665-670.

[10] 10. Ebersold M, Laws ER, Scheithauer BW, Randall RV. Pituitary apoplexy treated by transphenoidal surgery. J Neurosurg 1983;58:315-320.

[11] 11. Gorczyca W, Hardy J. Arterial supply of the human anterior pituitary gland. Neurosurgery 1987;20:369-378.

[12] 12. Holness RO, Ogundimu FA, Langille RA. Pituitary apoplexy following closed head trauma. J Neurosurg 1983;59:677-679.

[13] 13. Leclerc F, Grisoli F. Arterial blood supply of the normal pituitary gland. J Neurosurg 1983;58:678-681.

[14] 14. L'Huillier F, Combed C, Martin N, Leclerc X, Pruvo JP, Gaston A. Apport de I'IRM dans les adénomes hypophysaires à révélation aigüé: à propos de 7 observations. J Neuroradiol 1989;16:221-237.

[15] 15. Maccagnan P, Macedo CLD, Kayeth MJ et al. Conservative management of pituitary apoplexy: a prospective study. J Clin Endocrinol Metab 1995;80:2190-2197.

[16] 16. Mc Fadzen RM, Doyle D, Rampling R, Teasdale E, Teasdale G. Pituitary apoplexy and its effect on vision. Neurosurgery 1991;29:669-675.

[17] 17. Mohr G, Hardy J. Hemorrhage, necrosis and apoplexy in pituitary adenomas. Surg Neurol 1982;18:181-189.

[18] 18. Nourizadeh AR, Pitts FW. Hemorrhage into pituitary adenoma during anticoagulant therapy. JAMA 1965;193:623-625.

[19] 19. Poisson M, Van Effentere R, Mashaly R. Pituitary apoplexy with rectraction nistagnus. Ann Neurol 1980;7:286-325.

[20] 20. Proust F, Hanneguim D, Bellow F. et al. Apoplexie pituitaire a l'effort en deux temps. Neurochirurgie 1995;5:372-376.

[21] 21. Rovit RL, Fein JM. Pituitary apoplexy: a review and reappraisal. J Neurosurg 1972;37:280-288.

[22] 22. Stanfield JP. The blood supply of the human pituitary gland. J Anat 1960;94:257-273.

[23] 23. Sussman EB, Porro RS. Pituitary apoplexy: the role of atheromatous emboli. Stroke 1974;5:318-323.

[24] 24. Wakai S, Fukushima T, Teramoto A, Sano K. Pituitary apoplexy: its incidence and clinical significance. J Neurosurg 1981;55:187-193.

[25] 25. Weisberg LA. Pituitary apoplexy: association of degenerative change in pituitary adenoma with radiotherapy and detection by cerebral computed tomography. Am J Med 1977;63:109-115.

[26] 26. Wright RL, Ojemann RG, Drew JH. Hemorrhage into pituitary adenoma. Arch Neurol 1965;12:326-331.

[27] 27. Yamaji T, Ishibashi M, Kosaka K. et al. Pituitary apoplexy in acromegaly during bromocriptine therapy. Acta Endocrinol 1981:98:171-177.