Pituitary crisis and pituitary apoplexy
Introduction
Introduction to pituitary crisis and pituitary apoplexy When the function of the anterior pituitary is diminished, the adrenal cortex hormone and thyroid hormone are deficient, the body's stress ability is decreased, and the crisis is induced by infection, vomiting, diarrhea, dehydration, cold, hunger, and the application of sleeping pills or anesthetics. Pituitary tumor sudden intratumoral hemorrhage, infarction, necrosis, tumor expansion, causing acute neuroendocrine lesions called pituitary apoplexy. basic knowledge The proportion of illness: 0.003% Susceptible people: no specific people Mode of infection: non-infectious Complications: diarrhea, coma, diarrhea
Cause
Pituitary crisis and cause of pituitary apoplexy
Cause:
When the function of the anterior pituitary is diminished, the adrenal cortex hormone and thyroid hormone are deficient, the body's stress ability is decreased, and the disease is caused by infection, vomiting, diarrhea, dehydration, cold, hunger, etc., and application of sleeping pills or anesthetics.
Prevention
Pituitary crisis and pituitary apoplexy prevention
Avoid infection, vomiting, diarrhea, dehydration, cold, hunger and the use of sleeping pills or anesthetics to induce crises. In the diet, you should eat more high-fiber and fresh vegetables and fruits, balanced nutrition, including essential nutrients such as protein, sugar, fat, vitamins, trace elements and dietary fiber. Give full play to the complementary role of nutrients in food.
Complication
Pituitary crisis and pituitary apoplexy complications Complications, diarrhea, coma, diarrhea
First, infection
Second, pituitary crisis and coma, such as infection, diarrhea, vomiting, loss of water, hunger, cold, surgery, trauma and various sedatives, hypnotics, hypoglycemic agents, etc. can induce pituitary crisis, symptoms are High-heat type (>40°C), low-temperature type (<30°C), hypoglycemia type, circulatory failure type, water poisoning type, etc., sometimes mixed type, mental disorder, paralysis, high fever, low temperature, nausea, vomiting, hypoglycemia Symptoms, fainting, coma and other symptoms.
Third, women lack LH and FSH, often complicated by amenorrhea, secondary sexual deterioration, infertility, castration or menopausal female symptoms is a typical manifestation of gonad state. Men lack gonadotropin, often with impotence, testicular atrophy, secondary sexual deterioration and reduced sperm production with infertility.
Symptom
Pituitary crisis and pituitary stroke symptoms Common symptoms Increased intracranial pressure and hyperthermia hypothermia Dehydration after pituitary resection Postpartum pituitary necrosis Vital signs Changes intestinal dysfunction Infection induced coma hypotension
1. History, symptoms and signs
(1) Type of crisis:
1. hypoglycemia coma; most common, more than eating too little, hunger or fasting or after injection of insulin, manifested as hypoglycemia symptoms; fainting (can have epileptic seizures, even coma) and hypotension, with hypopituitarism A history of illness can be diagnosed by detecting hypoglycemia.
2. Infection induces coma; manifests as high fever, coma after infection and hypotension.
3. Central nervous system inhibitors induce coma; general doses of sedatives and anesthetics can cause patients to fall into a long period of slumber and even coma, according to the history is not difficult to diagnose.
4. Low temperature coma: more induced by cold in winter, characterized by hypothermia and coma.
5. Loss of sodium coma: mostly due to surgery or gastrointestinal dysfunction caused by sodium dehydration, leading to peripheral circulatory failure.
6. Aquatic coma: Due to the original drainage disorder of the disease, excessive water intake can cause water poisoning, mainly manifested as water retention syndrome, low blood sodium and blood cell pressure reduction.
(2) Pituitary stroke:
Main performance
1 sudden onset of symptoms of increased intracranial pressure;
2 often have symptoms of adjacent tissue compression of the sella, such as upward oppression of visual pathways, diencephalon and midbrain, causing vision loss, visual field defects and vital signs changes; downward pressure on the thalamus causes blood pressure, body temperature, respiratory and heart rhythm disorders; compression side Invasion into the cavernous sinus causes extraocular muscle paralysis, trigeminal symptoms and venous return disorders;
3 symptoms of hypothalamic-pituitary dysfunction, there are still many patients with pituitary apoplexy lacking the symptoms of the original pituitary adenoma, so the sudden increase in intracranial pressure caused by unexplained causes, especially with visual impairment, optic nerve paralysis and other symptoms of compression Should be alert to pituitary apoplexy.
Examine
Pituitary crisis and pituitary apoplexy
The function of the pituitary gland can be reflected by the functional status of the target gland to which it is administered.
First, the determination of gonadal function in women has decreased blood estradiol levels, no ovulation and changes in basal body temperature, vaginal smears have no periodic changes in estrogen action, men see blood levels decreased or normal low values, semen check sperm count Reduced, morphological changes, poor mobility, and less semen.
Second, adrenal cortical function 24 hours urine 17-hydroxycorticosteroids and free cortisol discharge decreased, plasma cortisol concentration decreased, but the rhythm is normal, glucose tolerance test shows blood glucose low curve.
3. Determination of thyroid function The total serum T 4 and free T 4 were decreased, while the total T 3 and free T 3 were normal or decreased.
4. The pituitary secretion hormones such as FSH, LH, TSH, ACTH, GH, PRL are all reduced, but because the pituitary sputum is pulsed secretion, it is appropriate to continuously draw the same amount of blood 3 times every 15 to 20 minutes. .
Simultaneous determination of pituitary gonadotropin and target gland hormone levels can better judge the hypoplasia of the target gland as primary or secondary. For the storage function of the secretory cells in the gland, excitatory tests such as GnRH, TRH, CRH, GHRH can be used. Hypothalamic hormones are used to detect the secretion of pituitary hormones. The results of the pituitary combined with excitatory test (TRH, GnRH, and membrane blood low) are judged by the results, but the normal low values are also abnormal. It should be noted that Sometimes the results can be compared with normal, ACTH test is important for the diagnosis of primary or secondary adrenal insufficiency. Membrane hypoglycemia test is not used in the elderly, coronary heart disease, convulsions and myxedema Patient.
The lesions of the pituitary-hypothalamus can be distinguished by CT and MRI, which is more accurate than the saddle X-ray and tomography. The non-invasive examination is used to understand the lesion location, size, nature and its degree of invasion to adjacent tissues. Non-cranial lesions can also be used to determine the cause of the primary disease through chest X-rays, chest and abdomen CT, MRI, liver, bone marrow and lymph nodes.
Diagnosis
Diagnosis of pituitary crisis and pituitary apoplexy
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
It should be differentiated from aneurysm rupture, brain abscess, encephalitis and retrobulbar optic neuritis.
