Pituitary apoplexy

Pituitary apoplexy yog qhov tsis tshua muaj, tab sis qhov mob hnyav ntawm lub qog pituitary.

Lub pituitary yog ib lub caj pas me me ntawm lub hauv paus ntawm lub paj hlwb. Lub pituitary ua ntau yam ntawm cov tshuaj hormones uas tswj kev ua haujlwm hauv lub cev.

Pituitary apoplexy tuaj yeem tshwm sim los ntshav los rau hauv lub pituitary lossis txhaws ntshav ntws mus rau lub pituitary. Apoplexy txhais tau hais tias los ntshav mus rau hauv ib qho khoom nruab nrog lossis poob ntawm cov ntshav txaus rau ib lub nrog cev.

Tus mob Pituitary apoplexy feem ntau tshwm sim los ntawm cov ntshav tawm hauv lub cev (tsis mob) cov qog ntshav ntawm lub pituitary. Cov hlav no ua tau ntau yam thiab feem ntau tsis kuaj mob. Lub pituitary yog puas ntsoog thaum cov qog loj dheev. Nws ua rau ntshav rau lub pituitary lossis thaiv cov ntshav rau lub pituitary. Qhov loj dua cov qog, qhov ntau dua kev pheej hmoo rau yav tom ntej pituitary apoplexy.

Thaum mob pituitary los ntshav hauv tus poj niam lub sijhawm lossis tom qab yug menyuam, nws yog hu ua Sheehan syndrome. Nov yog qhov mob uas tsis tshua muaj heev.

Cov teeb meem pheej hmoo rau pituitary apoplexy rau cov neeg tsis cev xeeb tub tsis muaj mob qog suav nrog:

• Los ntshav kev ntshawv siab
• Mob ntshav qab zib
• Lub taub hau raug mob
• Tawg rau lub caj pas pituitary
• Kev siv lub tshuab ua pa

Cov hlwb tsis zoo nyob hauv cov xwm txheej no muaj tsawg heev.

Pituitary apoplexy feem ntau muaj lub sijhawm luv luv ntawm cov tsos mob (mob hnyav), uas tuaj yeem ua rau muaj kev phom sij txog lub neej. Cov tsos mob feem ntau muaj xws li:

• Mob taub hau loj heev (ua phem tshaj hauv koj lub neej)
• Paralysis ntawm lub qhov muag cov leeg, ua rau pom ob lub qhov muag (ophthalmoplegia) los yog teeb meem qhib daim tawv muag
• Kev ploj los ntawm qhov pom kev tsis pom kev lossis tsis pom kev ntawm lub zeem muag hauv ib lossis ob lub qhov muag
• Tsis tshua muaj ntshav siab, xeev siab, tsis qab los noj mov, thiab ntuav los ntawm qhov tsis txaus adrenal tsis txaus
• Cov kev hloov pauv ntawm tus kheej vim los ntawm txoj kev nqaim ib ntawm cov hlab ntsha hauv lub hlwb (anterior cerebral artery)

Tsawg me ntsis, pituitary kawg ua haujlwm yuav tshwm sim qeeb dua. Hauv Sheehan syndrome, piv txwv li, thawj qhov tsos mob tshwm sim tej zaum yuav ua tsis tiav los ua cov mis nyuj uas tshwm sim los ntawm qhov tsis muaj cov tshuaj prolactin.

Sij hawm dhau sijhawm, teeb meem nrog lwm cov tshuaj hormones pituitary tuaj yeem tsim, ua rau cov tsos mob ntawm cov mob hauv qab no:

• Kev loj hlob hormone tsis txaus
• Adrenal tsis txaus (yog tias tsis tau tam sim no lossis kho)
• Hypogonadism (cov qog ntshav hauv lub cev tsim tawm me lossis tsis muaj tshuaj hormones)
• Hypothyroidism (Cov thyroid caj pas tsis ua cov thyroid hormones txaus)

Qee qhov tsis tshua muaj, thaum tom qab (sab tom qab) ntawm tus pituitary cuam tshuam nrog, cov tsos mob yuav suav nrog:

• Plam plab hauv lub tsev menyuam tuaj cog lus yug me nyuam (hauv cov poj niam)
• Ua tsis tau leej niam mis (hauv poj niam)
• Nquag tso zis thiab nqhis dej heev (ntshav qab zib insipidus)

Tus kws kho mob yuav kuaj ib ce thiab nug txog koj cov tsos mob.

Kev ntsuam xyuas uas yuav raug txiav txim suav nrog:

• Kev kuaj qhov muag
• MRI lossis CT scan

Kev kuaj ntshav yuav ua kom ntsuas cov theem ntawm:

• ACTH (adrenocorticotropic hormone)
• Cortisol
• FSH (follicle-stimulating hormone)
• Kev loj hlob lawm
• LH (luteinizing hormone)
• Prolactin
• TSH (cov thyroid-stimulating lawm)
• Insulin-zoo li qhov kev loj hlob-1 (IGF-1)
• Kev Sodium
• Osmolarity hauv ntshav thiab zis

Mob apoplexy tej zaum yuav tsum tau kev phais mob kom txo tau lub siab ntawm tus pituitary thiab txhim kho cov tsos mob pom kev. Cov mob hnyav yuav tsum tau phais mob thaum muaj xwm txheej ceev. Yog tias tsis pom kev zoo cuam tshuam, kev phais mob feem ntau tsis tsim nyog.

Kev kho mob sai nrog cov tshuaj adrenal hloov pauv (glucocorticoids) yuav xav tau. Cov tshuaj hormones no feem ntau yog muab los ntawm cov hlab ntsha (los ntawm IV). Lwm cov tshuaj hormones yuav thaum kawg hloov, suav nrog:

• Kev loj hlob lawm
• Cov tshuaj hormones poj niam txiv neej (estrogen / testosterone)
• Cov thyroid hormones
• Vasopressin (ADH)

Mob taub hau mob apoplexy tuaj yeem ua rau lub neej taus. Qhov kev kuaj pom zoo yog qhov zoo rau cov neeg uas muaj kev mob qog txhaws ntev (ntev) uas yog kuaj thiab kho.

Teeb meem ntawm kev tsis kho tus mob apoplexy tuaj yeem suav nrog:

• Kev nyuaj siab adrenal (mob uas tshwm sim thaum tsis muaj cortisol txaus, ib yam tshuaj tsim los ntawm cov qog adrenal)
• Tsis pom kev

Yog tias lwm cov tshuaj hormones ploj lawm tsis hloov, cov tsos mob ntawm hypothyroidism thiab hypogonadism yuav tshwm sim, suav nrog kev muaj mob hauv lub cev.

Hu rau koj tus kws kho mob yog tias koj muaj cov tsos mob tshwm sim ntawm lub hlwb tsis muaj txaus.

Mus rau chav kho mob ceev lossis hu rau tus npawb xov tooj xwm ceev hauv nroog (xws li 911) yog tias koj muaj cov tsos mob ntawm tus mob apoplexy, suav nrog:

• Qhov muag leeg tsis muaj zog lossis tsis pom kev
• Dheev, mob taub hau heev
• Mob ntshav siab (uas tuaj yeem ua rau tsaus muag)
• Xeev siab
• Ntuav

Yog tias koj muaj cov tsos mob no thiab koj twb tau kuaj mob qog nqaij hlav pituitary, mus nrhiav kev pab kho mob tam sim ntawd.

Pituitary infarction; Cov qog pob qog nqaij hlav apoplexy

• Cov qog endocrine

Hannoush ZC, Weiss RE. Pituitary apoplexy. Hauv: Feingold KR, Anawalt B, Boyce A, li al, eds. Endotext [Is Taws Nem]Cov. Sab Qab Teb Dartmouth, MA: MDText.com. Xyoo 2000-. www.ncbi.nlm.nih.gov/books/NBK279125. Hloov kho thaum Lub Plaub Hlis 22, 2018. Nkag Mus Saib Lub Tsib Hlis 20, 2019.

Melmed S, Kleinberg D. Pituitary pawg thiab qog. Hauv: Melmed S, Polonsky KS, Larsen PR, Kronenberg HM, eds. Williams Phau Ntawv ntawm EndocrinologyCov. 13th ed. Philadelphia, PA: Elsevier; 2016: chap 9.