Diagnóstico y manejo de la apoplejía hipofisaria

  • A. Orrego Asociación Colombiana de Endocrinología, Diabetes y Metabolismo
  • A. Jácome Asociación Colombiana de Endocrinología, Diabetes y Metabolismo

Resumen

La apoplejía hipofisaria (o pituitaria) se caracteriza por necrosis isquémica o hemorragia en el interior de un tumor hipofisario. Aunque puede presentarse espontáneamente en adenomas preexistentes, hay factores precipitantes como la hipertensión, embarazo, bromocriptina, pruebas dinámicas endocrinas realizadas preoperatoriamente, radioterapia sobre la hipófisis o cirugía cardíaca. La apoplejía hipofisaria clásica es una emergencia médica, y se debe administrar hidrocortisona rápidamente para salvar la vida del paciente. Cursa con cefalea súbita, vómito, irritación meníngea, cambios en la agudeza visual y a veces nivel de conciencia reducido. Pueden verse o no signos neurológicos, en el primer caso con compromiso de los pares craneanos segundo, tercero, cuarto y sexto. Las pruebas imagenológicas, en especial la resonancia magnética, son indispensables. Se debate si el tratamiento debe ser quirúrgico o conservador, dependiendo de la progresión y agresividad de los síntomas. El tratamiento quirúrgico consiste en la descompresión selar transesfenoidal inmediata y terapia de reemplazo con dosis elevadas de corticoides. Sin embargo, se discute si el manejo conservador de observación es una alternativa adecuada cuando mejoran o desaparecen los síntomas y hay estabilidad.

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Biografía del autor

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Médico Internista Endocrinólogo, Miembro Honorario de la Asociación Colombiana de Endocrinología, Diabetes y Metabolismo.

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Médico Internista Endocrinólogo, Miembro Honorario de la Asociación Colombiana de Endocrinología, Diabetes y Metabolismo. Miembro de Número de la Academia Nacional de Medicina y de la Sociedad Colombiana de Historia de la Medicina. Editor Emérito, Revista Medicina.

Citas

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Publicado
2019-10-26
##submission.howToCite##
ORREGO, A.; JÁCOME, A.. Diagnóstico y manejo de la apoplejía hipofisaria. Revista Colombiana de Endocrinología, Diabetes & Metabolismo, [S.l.], v. 6, n. 3, p. 188-197, oct. 2019. ISSN 2389-9786. Disponible en: <http://revistaendocrino.org/index.php/rcedm/article/view/533>. Fecha de acceso: 15 nov. 2019
Sección
Articulos de Revisión