Pituitary crisis and pituitary apoplexy

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Pituitary crisis and pituitary apoplexy, the anterior hypopituitarism, adrenal cortical hormone and thyroid hormone deficiency, decreased bo


Pituitary crisis and pituitary apoplexy, the anterior hypopituitarism, adrenal cortical hormone and thyroid hormone deficiency, decreased body stress ability, in infection, vomiting, diarrhea, dehydration, cold and hunger situation and application of hypnotics or narcotics induced crisis. Intracranial hemorrhage, infarction and necrosis of pituitary tumor, enlargement of the tumor, and acute neuroendocrine lesion caused by pituitary apoplexy. Directory 1 etiology

2 clinical manifestations

3 check

4 diagnosis

5 treatment

1 causes of hypopituitarism pituitary, adrenal cortical hormone and thyroid hormone deficiency, decreased body stress ability, cause the disease after infection, vomiting, diarrhea, dehydration, cold and hunger situation and application of hypnotics or narcotics. 2 the clinical manifestations of the 1 crisis (1) more than the most common hypoglycemic coma, eating too little, starvation or fasting or after insulin injection onset. Is hypoglycemia symptoms; syncope (with epileptic seizures, and even coma) and hypotension. There is a history of hypopituitarism, detection of low blood sugar can be diagnosed. (2) infection induced coma showed high fever, coma after infection and low blood pressure. (3) central nervous depressant sedative and anesthetic dose induced coma can make patients into a long period of lethargy and coma. According to the history is not difficult to diagnose. (4) low temperature coma induced by cold winter, characterized by hypothermia and coma. (5) loss of sodium coma due to surgery or gastrointestinal dysfunction caused by the loss of sodium dehydration, causing peripheral circulatory failure. (6) water intoxication coma due to the drainage of the disease, excessive water can cause water poisoning. The main manifestations were water retention syndrome, hyponatremia and hematocrit. 2 pituitary apoplexy (1) sudden onset of intracranial hypertension. (2) sella adjacent tissue compression symptoms such as to the oppression of the visual pathway, diencephalon and mesencephalon, caused by decreased visual acuity, visual field defects and vital signs change; downward pressure and temperature, caused by the oppression of the thalamus and respiratory arrhythmia; compression side into the cavernous sinus caused by extraocular muscle paralysis, trigeminal nerve symptoms and venous reflux disorder. (3) there are hypothalamic pituitary dysfunction symptoms of many pituitary apoplexy patients lack the original symptoms of pituitary adenoma, so sudden unexplained intracranial pressure increased, especially with visual impairment, ophthalmoplegia and compression symptoms, should be alert to pituitary apoplexy. 3 examination of the function of the pituitary gland can be reflected by the function of the target gland. 1 women have the determination of gonadal function, serum estradiol levels decreased, no ovulation and basal body temperature change, no periodic vaginal smear estrogen change, male blood levels decreased or normal Gu intoxicated low value, the number of semen sperm decreased, morphological changes, poor activity, less semen. 2 adrenocortical function 24 hours urinary free cortisol and 17- hydroxycorticosteroid displacement decreased, the plasma cortisol concentration was significantly decreased, but the rhythm of normal glucose tolerance test showed low blood glucose curve. 3 the serum total T4 and free T4 were decreased, while the total T3 and free T3 were normal or decreased. 4 pituitary hormones such as FSH, LH, TSH, ACTH, GH, PRL were reduced, but because we are pulsatile secretion of pituitary, it should be every 15 to 20 minutes of continuous extraction of equivalent blood 3 times, evacuation phase detection. At the same time, the level of pituitary stimulating hormone and target gland hormone can be determined, which can be used to judge whether the target gland function is primary or secondary. The test for endocrine cells in the pituitary secretion reserve function, such as GnRH, TRH, CRH reaction and GHRH to detect the hypothalamic hormone pituitary hormone. The pituitary gland combined stimulation test (TRH, GnRH, membrane island in low results if less than normal, blood) to determine the significance, but also is a normal low value anomaly. It should be noted that, at times, the results can be compared with those of normal re examination, and the ACTH test is of great significance in the diagnosis of primary or secondary adrenocortical hypofunction. Low frequency stimulation test of membrane island is not used in elderly patients with coronary heart disease, convulsions and mucous edema. 5 imaging examination for the lesion of anterior pituitary hypothalamic CT, MRI is available from sella radiography and tomography is more accurate, as far as possible by non-invasive examination, understand the location and size of lesions, and the properties of adjacent tissue invasion. For non brain lesions can also be chest X-ray, chest and abdomen CT, MRI, liver, bone marrow and lymph nodes and other parts of the biopsy, to determine the cause of the primary disease. 4 diagnosis can be made according to the etiology, clinical manifestations and laboratory tests. 5 for 1 general treatment after intravenous injection of 50% glucose 40 ~ 60ml, followed by 10% ~ 1000ml in 500 glucose, plus hydrocortisone infusion, but low temperature coma of hydrocortisone dosage should not be too large. 2 low temperature type and treatment of myxedema coma is similar, but must pay attention to use of thyroid hormone before (at least) increase with the amount of hydrocortisone. In addition, prohibited the use of chlorpromazine, pentobarbital and other central inhibitors. 3 loss of sodium coma should be sodium liquid, and adrenal crisis specific method of the same. 4 water poisoning coma immediately given moderate doses of glucocorticoids, and to limit water. 5 pituitary apoplexy should be treated with hormone replacement therapy, hemostatic agent, etc.. To test the water and salt metabolism in diabetes insipidus or abnormal secretion of antidiuretic hormone; in case of serious increased intracranial pressure, decreased visual acuity, coma, disease worsening, surgical decompression should be. Baidu Encyclopedia



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