下垂体卒中—その頻度と臨床的意義

PITUITARY APOPLEXY : IT'S INCIDENCE AND CLINICAL SIGNIFICANCE

　下垂体卒中（pituitary apoplexy）は1905年にBlei—btreu^5）がはじめて報告して以来良く知られるようになつた疾患で，突然に発症する頭痛，嘔吐，視力障害，複視，意識障害，内分泌機能障害などを特徴とする。本疾患の病態は下垂体腫瘍内の出血あるいは出血性梗塞によつて腫瘍体積が急激に増大するために惹起されると考えられている。現在までに数100例の報告がある^{1〜4,6,7,12，14〜16,18,19,21,22,26,28,29,31〜35,37〜55,57〜64,66〜70）}が，その頻度については1.5〜27.7％と報告によりかなり幅があり一定しない^{26,31,40,41,45,67）}。しかもこれまで何らの系統的な分析はなされていない。そこで私達は本研究において，自験例の下垂体腫瘍560例を対象に腫瘍からの出血の頻度を検索し，年齢，性，腫瘍の大きさ，内分泌機能，組織型との関係を分析したので報告する。

We have investigated the occurrence of hemor-rhage from pituitary adenoma (so-called pituitary apoplexy) in a consecutive series of 560 cases oper-ated on in our institute during the past 30 years. There were 93 cases (16.6%) in which hemorrhage from pituitary adenomas was confirmed either clinically or surgically. We have analyzed these cases in terms of age, sex, symptoms and signs, size,hormonal function and histological types of ade-nomas and CT findings. In 90 cases (16.1%), hema-toma or old bloody fluid were verified within tumor tissue at surgery. Three other patients presented with subarachnoid hemorrhage, but there was no detectable intratumor hematoma in any of them. Among these 93 cases, 42 (7.5%) showed no evi-dence of clinical symptoms related to hemorrhage (asymptomatic hemorrhage). Fifty-one cases (9.1%) had definite histories of acute episode that sug-gested sudden bleeding (symptomatic hemorrhage-pituitary apoplexy). Thirty-eight of them (6.8%) had major attack which was represented by distur-bances of consciousness, hemiparesis, loss of vision, or ocular palsy. In 2 acromegalic patients, pituitary apoplexy developed during bromocriptine treatment. There was a case of sudden death due to massive hemorrhage from the tumor 14 months after the completion of postoperative radiation therapy. The other 13 of symptomatic cases (2.3%) developed minor attack which included headache, nausea, vomiting and vertigo.

Bleeding from pituitary adenomas was not sta-tistically correlated with any of the following factors except for age: sex, hormonal function of adenomas and histological types. The number of asymptomatic cases in the third decade was signi-ficantly greater than that of the whole pituitary patients in the same decade. The present investi-gation revealed that the incidence of pituitary apoplexy was unexpectedly high: major attack in 6.8%, minor attack in 2.3% and asymptomatic hemorrhage in 7.5% of the cases. We conclude that this relatively high risk of pituitary apoplexy should be kept in mind in treating pituitary adenomas.