Prikaz serije bolesnika s apopleksijom tumora hipofize

master's thesis

• Title (english): Pituitary tumor apoplexy - clinical features of patient series
• Author: Josipa Župan
• Mentor: Tina Dušek (mentor)
• Committee member: Darko Kaštelan (predsjednik povjerenstva)
• Committee member: Nikola Đaković (član povjerenstva)
• Committee member: Tina Dušek (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Internal Medicine); Zagreb
• Defense date and country: 2016-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Internal Medicine

Abstract

Apopleksija tumora hipofize je klinički sindrom koji je karakteriziran iznenadnim napadajem glavobolje, ispadima vidnog polja, diplopijama, parezama, poremećenim mentalnim statusom i hormonskom disfunkcijom ili potpunom afunkcijom. Karakteristično je da se klinička slika razvija jako brzo, a simptomi zbog kojih su bolesnici prvotno hospitalizirani su glavobolja (95%), mučnina, povraćanje (69%), omaglice i dezorijentiranost. U ovoj studiji analizirani su bolesnici s apopleksijom tumora hipofize kojima je učinjena transsfenoidna resekcija tumora. Svi bolesnici su bili liječeni u razdoblju od 2008. do 2016. godine. Svi pacijenti su bili muškog spola prosječne dobi 55 godina (raspon od 44-78 godina). Kod svih pacijenata (100%) glavobolja se javila kao vodeći simptom, dok se glavobolja sa povraćanjem javila u 4 od 6 pacijenata (66%). Sveukupno, poremećaji vida u obliku ispada vidnog polja, pareze n. okulomotoriusa, dvoslika, ptoze kapka ili potpune sljepoće bili su prisutni u 5 od 6 pacijenata (83%). Tri bolesnika prezentirala su se kliničkom slikom meningitisa. Kod 4/6 pacijenata nađen je panhipopituitarizam dok su kod ostala 2/6 vrijednosti kortikotropne i tireotropne funkcije hipofize bile djelomično očuvane. Samo u jednog pacijenta došlo je do oporavka funkcije hipofize. Hiponatrijemijom su se prezentirala 2 od 6 pacijenata. Predisponirajući čimbenici kao što su hipertenzija su nađeni u 3/6 (50%) pacijenata dok je šećernu bolest imao samo jedan pacijent. Dvoje od šestero pacijenata bili su na trajnoj antiagregacijskoj terapiji. Rezultati ove studije upućuju da je diferencijalno dijagnostički potrebno razmotriti pituitarnu apopleksiju kod svih bolesnika s kliničkom slikom meningitisa praćenog negativnim bakteriološkim nalazom likvora, napose ako se radi o bolesnicima koji su na antiagregacijskoj terapiji. Limitacije ove studije čine mali broj ispitanika i retrospektivni dizajn.

Abstract (english)

Pituitary apoplexy is a clinical syndrome characterized by sudden onset of the headache, visual field disturbances, diplopias, paresis, altered mental status and hormone dysfunction or complete a function. Typically, the clinical picture develops very quickly. The patients are originally hospitalized for the symptoms like headache (95%), nausea, vomiting (69%), dizziness, and disorientation. The medical histories of patients with apoplexy pituitary tumor who underwent transphenoidal resection of the tumor were analyzed. All the patients were hospitalized and treated in the period from 2008 to 2016. All the patients were male and the average age was 55. The youngest patient was 44 and the oldest 78 years old. In all the patients headache (100%) appeared as the main symptom while vomiting occurred in 4 out of 6 patients (66%). Overall, visual disturbances in the form of visual field defects, paresis oculomotorius, double visions, eyelid ptosis or complete blindness were present in 83% (5/6). Three patients presented the clinical picture of meningitis. Panhypopituitarism was found in 4 patients while in other 2 values of ACTH and TSH were measured in low levels. Only one patient recovered the pituitary function 100%. Hyponatremia was present only in 2 patients. Predisposing factors such as hypertension were found in 50%, while only one patient had diabetes mellitus. Two of the six patients were on a permanent anticoagulation therapy. The study revealed that the differentially pituitary apoplexy should be considered in any patient with a clinical picture of meningitis accompanied by negative bacteriology fluid, especially in the case of patients who are on anticoagulation therapy. The flaw of our study is that it was done on a very small sample and it was made retrospectively.

• Keywords: apopleksija; glavobolja; meningitis; antikoagulantna terapija
• Keywords (english): apoplexy; headache; meningitis; anticoagulation therapy
• Language: croatian
• URN:NBN: urn:nbn:hr:105:645221
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2017-06-26 11:23:36