Pituitary ma ọ bụ pituitary apoplexy bụ ọrịa na-adịghị ahụkebe ma dị njọ. Ọ bụ ihe mberede ahụike chọrọ nlekọta kwesịrị ekwesị.

definition

Pituitary apoplexy bụ nkụchi obi ma ọ bụ ọbara ọgbụgba nke na-apụta na adenoma pituitary (akpụ akpụ endocrine na-adịghị mma, nke na-abụghị nke kansa nke na-amalite site na pituitary gland na ụbụrụ). N'ihe karịrị ọkara nke ikpe ahụ, apoplexy na-ekpughe adenoma nke na-enyeghị ihe mgbaàmà ọ bụla.

Eme 

Aghọtachaghị ihe na-akpata apoplexy pituitary. Pituitary adenomas bụ etuto ahụ na-agbapụta ma ọ bụ na-anwụ ngwa ngwa. Necrosis nwere ike ịbụ n'ihi ụkọ vaskụla. 

diagnostic

Ihe ngosi mberede (CT ma ọ bụ MRI) na-eme ka o kwe omume ime nchọpụta ahụ site n'igosi adenoma na usoro nke necrosis ma ọ bụ ọbara ọgbụgba. A na-ewerekwa nlele ọbara ngwa ngwa. 

Ndị ọ gbasara 

Pituitary apoplexy nwere ike ime n'afọ ọ bụla mana ọ na-adịkarị na 3s gị. Ụmụ nwoke na-emetụta ntakịrị karịa ụmụ nwanyị. Pituitary apoplexy na-emetụta 2% nke ndị nwere adenoma pituitary. N'ihe karịrị 3 / XNUMX nke ikpe, ndị ọrịa anaghị aghọta ịdị adị nke adenoma ha tupu nnukwu mgbagwoju anya. 

Ihe ize ndụ 

Ndị nwere adenoma pituitary na-enwekarị ihe na-ebute ụzọ ma ọ bụ ihe na-akpali akpali: ịṅụ ọgwụ ụfọdụ, nyocha ndị na-emerụ ahụ, pathologies dị elu (ọrịa shuga mellitus, nyocha angiographic, ọrịa coagulation, mgbochi coagulation, ule mkpali pituitary, radiotherapy, ime ime, ọgwụgwọ na bromocriptine, isorbide). , chlorpromazine ...)

Otú ọ dị, ihe ka ọtụtụ n'ime ọrịa strok na-eme n'enweghị ihe na-akpali akpali.

Pituitary ma ọ bụ pituitary apoplexy bụ ngwakọta nke ọtụtụ mgbaàmà, nke nwere ike ịpụta n'ime awa ma ọ bụ ụbọchị. 

isi ọwụwa 

Isi ọwụwa bụ ihe mgbaàmà mbụ. Isi ọwụwa na-acha odo odo dị n'ihe karịrị ụzọ atọ n'ụzọ anọ. Enwere ike jikọta ha na ọgbụgbọ, ọgbụgbọ, ahụ ọkụ, ọgba aghara nke mmụọ, si otú a na-enweta ọrịa meningeal. 

Mgbaghara anya 

N'ihe karịrị ọkara nke ikpe pituitary apoplexy, a na-ejikọta ọgba aghara anya na isi ọwụwa. Ndị a bụ mgbanwe a na-ahụ anya ma ọ bụ mfu nke anya anya. Nke a na-ahụkarị bụ hemianopia bitemporal (mfu nke ebe a na-ahụ anya n'akụkụ nke ọzọ nke ebe a na-ahụ anya). Ahụ mkpọnwụ Oculomotor bụkwa ihe a na-ahụkarị. 

Ọrịa endocrine 

Pituitary apoplexy na-esonyere ya na nnukwu ụkọ pituitary (hypopituitarism) nke na-adịghị ezu oke mgbe niile.

Nlekọta nke apoplexy pituitary bụ multidisciplinary: ophthalmologists, neuroradiologists, neurosurgeons na endocrinologists. 

Ọgwụgwọ apoplexy na-abụkarị ọgwụ. A na-emejuputa ngbanwe nke homonụ iji dozie ụkọ endocrinological: ọgwụgwọ corticosteroid, ọgwụgwọ homonụ thyroid. A hydro-electrolytic resuscitation. 

The apoplexy nwere ike ịbụ isiokwu nke a neurosurgical ọgwụgwọ. Nke a bu n'obi imebi ihe owuwu mpaghara yana ọkachasị ụzọ anya. 

Usoro ọgwụgwọ Corticosteroid bụ usoro, ma a na-agwọ aoplexy na neurosurgical ma ọ bụ na-enyocha ya na-enweghị ịwa ahụ (karịsịa ndị na-enweghị ebe a na-ahụ anya ma ọ bụ nsogbu anya na-adịghị ahụ anya na enweghị nkwarụ nke nsụhọ). 

Mgbe ntinye aka na-adị ngwa ngwa, a ga-enwe ike ịgbake n'ozuzu, ebe ọ bụrụ na oge ọgwụgwọ ọgwụgwọ nwere ike ịnwe ìsì na-adịgide adịgide ma ọ bụ hemianopia. 

N'ime ọnwa ndị na-esote apoplexy, a na-eme nyochaghachi ọrụ pituitary, iji hụ ma ọ bụrụ na enwere ụkọ pituitary na-adịgide adịgide.

Ọ gaghị ekwe omume n'ezie igbochi pituitary apoplexies. Otú ọ dị, ị gaghị eleghara ihe ịrịba ama nke nwere ike ịbụ nke adenoma pituitary, karịsịa nsogbu anya (adenomas nwere ike ịpịkọta irighiri akwara nke anya). 

Ịwa ahụ nke adenoma na-egbochi ihe omume ọzọ nke apoplexy pituitary. (1)

(1) Arafah BM, Taylor HC, Salazar R., Saadi H., Selman WR Apoplexy nke pituitary adenoma mgbe ule siri ike na gonadotropin na-ahapụ hormone. Am J Med 1989; 87 : 103-105