道路交通事故中作为 "偶发瘤 "的垂体神经腺瘤

Boddepalli Devaraj, K. A. Rupesh, Srinivasarao Vavilapalli, J. Allu
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摘要

:垂体腺瘤是蝶鞍区最常见的肿瘤。功能性垂体腺瘤因垂体功能低下或亢进以及肿块效应而表现出多种内分泌症状。由于压迫视神经、视交叉和海绵窦,它们会对视力产生缓慢但严重的影响:一名 42 岁的男性是当地一家大巴的保安,他在过马路时被一辆面包车撞倒。他头部受伤,在我们的三级病例研究所接受治疗期间不幸去世。尸检时,在检查头骨时,发现颅底上部有一个 5x5x3 厘米的肿块。这个肿块被送去进行组织病理学检查,结果证实它是一个 "垂体神经内分泌肿瘤,性质可能是促性腺激素瘤"。然而,该病例的死因被认定为 "头部受伤":法医病理学家很少遇到颅内肿瘤导致的突然死亡。据报道,尸检时发现的未确诊致命脑肿瘤的发生率在 0.02% 到 0.4% 之间。有几项研究调查了荷尔蒙活性垂体腺瘤与心理健康障碍和生活质量之间的关系。约翰逊(Johnson)等人的一项研究发现,与正常人群相比,无功能腺瘤患者的身体和情绪健康状况都有所下降。在本病例中,虽然头痛和视力症状只是偶然发现,并不是死亡原因,但我们不能低估肿瘤对死者视力的影响。尽管如此,肿瘤导致的视力损伤也可能是导致道路交通事故的部分原因。
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Pituitary neuroadenoma as an ‘Incidentaloma’ in a case of road traffic accident
: Pituitary adenomas are the most common tumors found in the Sella region. Functional pituitary adenomas exhibit a wide range of endocrine manifestations due to either hypo- or hyperfunction of the pituitary gland, as well as mass effect. They can have a slow but severe impact on vision due to compression of the optic nerves, optic chiasm and cavernous sinus.: A 42-year-old male, a security guard at a local dabha, was struck by a van while crossing the road. He sustained a head injury and unfortunately passed away during treatment at our tertiary case institute. At autopsy, upon examination of the skull, a mass measuring 5x5x3cm was discovered in the suprasellar area of base of skull. This mass was sent for histopathological examination, which confirmed it to be a "Pituitary neuroendocrine tumor possibly gonadotropic in nature." However, the cause of death in this case was opined as ‘Head injury’.: Forensic pathologists rarely encounter intracranial neoplasms that present as sudden and unexpected deaths. The incidence of undiagnosed fatal brain tumors detected at autopsy has been reported to range between 0.02% and 0.4%. Several studies have investigated the relationship between hormonally active pituitary adenomas and both mental health disorders and quality of life. One study by Johnson et al. found that patients with nonfunctional adenomas reported impairments in physical and emotional well-being compared to the normal population. Headache and visual symptoms are most commonly associated with pituitary adenomas.In the present case, although it was an incidental finding and not contributing to the cause of death, we cannot underestimate the effect of the tumor on the visual acuity of the decedent. Nonetheless, visual impairment due to the tumor could also have partially led to the road traffic accident.
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