Neurocirugía Neurocirugía
Neurocirugia.2003;14:504-11 - Vol. 14 Núm.6 DOI: 10.1016/S1130-1473(03)70508-9
Apoplejía hipofisaria
Pituitary apoplexy
F. Comuñas, R. Al-Ghanem, V. Calatayud Maldonado
Servicio de Neurocirugía. Hospital Clinico Universitario. Zaragoza
Recibido 23 marzo 2003, Aceptado 19 agosto 2003
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.

Summary

Pituitary apoplexy is an infrequent complication of pituitary adenomas, caused by hemorrhagic or ischemic infarction in the tumor, with typical clinical presentation: severe headache of sudden onset, visual disturbances, sleep tendency or comma.

Along the last ten years we have treated eight patients with pituitary apoplexy. The diagnostic was clinically established in all of them. Seven cases com-plained of severe headache and vomiting. Eight patients reported visual disturbances. In one case low level of consciousness and meningeal irritation were the only findings. In six cases the apoplexy was the first pituitary adenoma manifestation. MRI and CT studies demons-trated the pituitary stroke in seven patients.

Surgical trans-sphenoidal decompression was performed in seven patients, requiring urgent management in only one case.

All patients experienced a marked visual improvement, but there was no amelioration of endocrine preoperative disturbances in any case. We conclude that quick diagnosis, early onset of hormonal therapy and urgent or delayed trans-sphenoidal surgery, depending on clinical manifestations, constitute the principies of the appropriate treatment of pituitary apoplexy.

Palabras clave
Adenoma hipofisario, Apoplejía hipofisaria, Cirugía transesfenoidal
Key words
Pituitary adenoma, Pituitary apoplexy, Trans-sphenoidal surgery
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Comuñas, F.; Al-Ghanem, R.; Calatayud Maldonado, V.: Apoplejía hipofisaria. Neurocirugía 2003; 14: 504–511.

Correspondencia postal: Dr. Fernando Comuñas González. C/ Rubén Darío 2, l°-lª. 50012 Zaragoza.
Copyright © 2003. Sociedad Española de Neurocirugía
Neurocirugia.2003;14:504-11 - Vol. 14 Núm.6 DOI: 10.1016/S1130-1473(03)70508-9