Neurocirugía Neurocirugía
Neurocirugia. 2003;14:504-11. - Vol. 14 Núm.06 DOI: 10.1016/S1130-1473(03)70508-9

Apoplejía hipofisaria

F. Comuñasa, R. Al-Ghanema, V. Calatayud Maldonadoa

a Servicio de Neurocirugía. Hospital Clinico Universitario. Zaragoza

Palabras clave

Adenoma hipofisario. Apoplejía hipofisaria. Cirugía transesfenoidal.

Resumen

La apoplejía hipofisaria es una complicación poco frecuente de los adenomas de hipófisis, producida por un infarto hemorrágico o isquémico en el adenoma y con una clínica característica: cefalea intensa de comienzo agudo, alteraciones visuales y somnolencia o coma.

En los últimos 10 años hemos tratado a 8 pacientes con apoplejía hipofisaria. El diagnóstico fue clínico: 7 presentaron cefalea intensa y vómitos, 8 alteraciones visuales y 1 disminución del nivel de conciencia asociado a síndrome meníngeo. En 6 casos, la apoplejía fue la primera manifestación del adenoma de hipófisis. La resonancia magnética y la tomografía computada demostraron el ictus hipofisario en 7 pacientes. La cirugía descompresiva transesfenoidal se efectuó en 7 casos, sólo en uno de urgencia. Todos presentaron una significativa recuperación de las alteraciones visuales, sin embargo, en ninguno se observó mejoría de las alteraciones endocrinológicas preoperatorias.

Consideramos que el diagnóstico precoz, el rápido inicio del tratamiento hormonal sustitutivo y la cirugía transesfenoidal urgente o diferida en función de la clínica, deben ser la base del tratamiento adecuado de la apoplejía hipofisaria.

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