Ulus Travma Acil Cerrahi Derg. 2022; 28(4): 483-489 | DOI: 10.14744/tjtes.2021.93539

Hipofizer apopleksi: Hipofiz adenomalarýnýn acil ve potansiyel olarak hayatý tehdit eden komplikasyonu

Abidin Murat Geyik¹, Mehmet Ozan Durmaz², Adem Dogan², Berna Kaya Uður³, Sýrma Geyik⁴, Ýbrahim Erkutlu¹, Soner Yasar², Alparslan Kýrýk², Gulsah Kose⁵, Ali Nehir^1
1Gaziantep Üniversitesi Týp Fakültesi, Beyin ve Sinir Cerrahisi Anabilim Dalý, Gaziantep
²Saðlýk Bilimleri Üniversitesi, Gülhane Eðitim ve Araþtýrma Hastanesi, Beyin ve Sinir Cerrahisi Anabilim Dalý, Ankara
³Gaziantep Üniversitesi Týp Fakültesi, Anestezi ve Reanimasyon Anabilim Dalý, Gaziantep
⁴Gaziantep Üniversitesi Týp Fakültesi, Nöroloji Anabilim Dalý, Gaziantep
⁵Muðla Sýtký Koçman Üniversitesi, Saðlýk Bilimleri Fakültesi, Hemþirelik Bölümü, Muðla

AMAÇ: Hipofizer apopleksi, uygun þekilde tedavi edilmezse, hipofiz adenomalarýnýn acil ve potansiyel olarak yaþamý tehdit eden bir komplikasyonudur. Çalýþmamýzýn amacý, hipofiz adenomalarý çalýþmamýzý sunmak ve bu nadir komplikasyonun klinik, radyolojik ve cerrahi özelliklerine odaklanmaktýr. GEREÇ VE YÖNTEM: Bu çalýþmada 2016–2018 yýllarý arasýnda toplam 143 hipofiz adenomalý hastaya cerrahi tedavi uygulandý. Tüm hastalar endos-kopik endonazal transsfenoidal (EET) teknik ile ameliyat edildi. Hipofizer apopleksi olgularýnýn verileri kaydedildi. Hipofizer apopleksi hastalarýnýn rezeksiyon oranlarý, hormonal sonuçlarý ve vizüel sonuçlarý deðerlendirildi.
BULGULAR: Yüz kýrk üç hastanýn sekizinde (%5.59) hipofizer apopleksi semptomlarý ve radyolojik bulgularý vardý. Ortalama yaþ 26.75 olup dördü (%50) erkek, dördü ise kadýndý. Ameliyat öncesi ortalama Knosp derecelendirme skoru 2.1 idi. Sekiz hastanýn hepsine acil cerrahi giriþim uygulandý ve apopleksi hastalarýnýn %75’inde total rezeksiyon saðlandý. Hormon düzeyleri ameliyat sonrasý prolaktin dýþýnda anlamlý olarak azaldý (p<0.05). Bir hastada beyin omurilik sývýsý sýzýntýsý meydana geldi. Hipofizer apopleksi hastalarýnýn hiçbirisi ölmedi.
TARTIÞMA: Hipofizer apopleksi, hipofiz adenomalarýnýn önemli bir komplikasyonudur. Erken taný ve cerrahi müdahale mükemmel oftalmolojik ve hormonal sonuçlar saðlar. Acil EET yaklaþým, oftalmolojik bulgularý ve makroadenomlarý olan hastalar için çok önemlidir.

Anahtar Kelimeler: Endoskop, hipofiz adenomasý, hipofizer apopleksi, sonuç.

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Pituitary apoplexy: An emergent and potential life-threatening complication of pituitary adenomas

Abidin Murat Geyik¹, Mehmet Ozan Durmaz², Adem Dogan², Berna Kaya Uður³, Sýrma Geyik⁴, Ýbrahim Erkutlu¹, Soner Yasar², Alparslan Kýrýk², Gulsah Kose⁵, Ali Nehir^1
1Department of Neurosurgery, Gaziantep University Faculty of Medicine, Gaziantep-Turkey
²Department of Neurosurgery, University of Health Sciences, Gülhane Training and Research Hospital, Ankara-Turkey
³Department of Anesthesiology, Gaziantep University Faculty of Medicine, Gaziantep-Turkey
⁴Department of Neurology, Gaziantep University Faculty of Medicine, Gaziantep-Turkey
⁵Department of Nursing, Muðla Sýtký Koçman University, Faculty of Health Sciences, Muðla-Turkey

BACKGROUND: Pituitary apoplexy is an emergent and potential life-threatening complication of pituitary adenomas if not managed properly. The aim of our study is to present our series of pituitary adenomas and to focus on the clinical, radiological, and surgical characteristics of this rare complication.
METHODS: In this study, a total of 143 patients with pituitary adenoma underwent surgical treatment between 2016 and 2018. All patients were operated using endoscopic endonasal transsphenoidal (EET) technique. The data of pituitary apoplexy cases were recorded. Resection rates, hormonal results, and visual outcomes of patients with pituitary apoplexy were evaluated.
RESULTS: Of the 143 patients, 8 (5.59%) were presented with the symptoms and radiological findings of pituitary apoplexy. The mean age was 26.75 years, and 4 (50%) of them were male and 4 were female. Pre-operative mean Knosp grading score was 2.1 All of eight patients underwent emergent surgical intervention and total resection was achieved in 75% of patients with apoplexy. Hormone levels were significantly decreased after surgery (p<0.05), except prolactin (p>0.05). Cerebrospinal fluid leakage occurred in one pa-tient. None of the patient with pituitary apoplexy died in our series.
CONCLUSION: Pituitary apoplexy is an important complication of pituitary adenomas. Early diagnosis and surgical intervention provide excellent ophthalmological and hormonal outcomes. Emergent EET approach is crucial for patients with ophthalmological findings and macroadenomas.

Keywords: Endoscope, outcome, pituitary adenoma, pituitary apoplexy.

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