内分泌 / 脳神経外科 / 眼科
下垂体卒中
突然の激しい頭痛+視力/眼球運動障害。経験的ステロイドと緊急画像・内分泌評価。
根拠：UK consensus / Endotext。各ノードはガイドラインの判断ロジックを要約したものであり、原文の転載ではありません。 医療従事者向けの参考情報であり、臨床判断の代替ではありません。日本の関連学会指針および施設プロトコルを優先してください。
ステップごとに回答すると、結論と対応の目安が表示されます。前の質問に戻ることもできます。
ステップ 1 · Is pituitary apoplexy suspected
Sudden severe headache + visual/ocular motor signs — pituitary apoplexy suspected?
💡 Sudden hemorrhage/infarction of the pituitary (usually a pre-existing adenoma) → rapid sellar expansion compressing the pituitary/optic chiasm/cavernous sinus. Presentation: sudden severe headache + nausea/vomiting + visual field defect (bitemporal hemianopia)/visual loss + ophthalmoplegia (CN III/IV/VI) + altered consciousness (apoplexy triad: headache + vomiting + visual disturbance), mimicking SAH/meningitis. Most urgent: acute adrenal insufficiency (ACTH deficiency) → hypotension/circulatory collapse/hyponatremia/hypoglycemia. Diagnosis: urgent MRI; check cortisol/ACTH/electrolytes/glucose.
パス全体像
- 【判断】Is pituitary apoplexy suspectedSudden severe headache + visual/ocular motor signs — pituitary apoplexy suspected?（Sudden hemorrhage/infarction of the pituitary (usually a pre-existing adenoma) → rapid sellar expansion compressing the pituitary/optic chiasm/cavernous sinus. Presentation: sudden severe headache + nausea/vomiting + visual field defect (bitemporal hemianopia)/visual loss + ophthalmoplegia (CN III/IV/VI) + altered consciousness (apoplexy triad: headache + vomiting + visual disturbance), mimicking SAH/meningitis. Most urgent: acute adrenal insufficiency (ACTH deficiency) → hypotension/circulatory collapse/hyponatremia/hypoglycemia. Diagnosis: urgent MRI; check cortisol/ACTH/electrolytes/glucose.）
- Pituitary apoplexy suspected → Suspected apoplexy → hydrocortisone + MRI
- Does not fit → Does not fit · differentiate sudden headache
- 【終点】Does not fit · differentiate sudden headache下垂体卒中の当該分岐。適応・禁忌を確認し、最新ガイドラインと施設プロトコルに沿って実施。必要時専門医に相談。
- 【終点】Suspected apoplexy → hydrocortisone + MRI直ちに give empiric IV hydrocortisone (stress dose 100–200 mg,次いで50–100 mg q6–8h) (treats presumed adrenal insufficiency, life-saving, do not waitに対しconfirmation) + hemodynamic/electrolyte/glucose support; 緊急 MRI, full endocrine panel (draw blood first). Multidisciplinary (neuro手術/endocrinology/ophthalmology) — 重症またはprogressive visual loss, altered consciousness → transsphenoidal surgical 減圧 (good outcomeの場合early), stable 〜なしで significant deficit may be managed conservatively; later hormone replacement (hypopituitarism is common).
よくある質問
- 下垂体卒中はどの臨床課題を扱う診療パスですか？
- 突然の激しい頭痛+視力/眼球運動障害。経験的ステロイドと緊急画像・内分泌評価。
- 下垂体卒中の主要な意思決定ステップは何ですか？
- Is pituitary apoplexy suspected
- 下垂体卒中はどのような対応方針を示しますか？
- Does not fit · differentiate sudden headache：下垂体卒中の当該分岐。適応・禁忌を確認し、最新ガイドラインと施設プロトコルに沿って実施。必要時専門医に相談。；Suspected apoplexy → hydrocortisone + MRI：直ちに give empiric IV hydrocortisone (stress dose 100–200 mg,次いで50–100 mg q6–8h) (treats presumed adrenal insufficiency, life-saving, do not waitに対しconfirmation) + hemodynamic/electrolyte/glucose support; 緊急 MRI, full endocrine panel (draw blood first). Multidisciplinary (neuro手術/endocrinology/ophthalmology) — 重症またはprogressive visual loss, altered consciousness → transsphenoidal surgical 減圧 (good outcomeの場合early), stable 〜なしで significant deficit may be managed conservatively; later hormone replacement (hypopituitarism is common).
- 下垂体卒中のうち直ちに対応が必要な状況はどれですか？
- Suspected apoplexy → hydrocortisone + MRI：直ちに give empiric IV hydrocortisone (stress dose 100–200 mg,次いで50–100 mg q6–8h) (treats presumed adrenal insufficiency, life-saving, do not waitに対しconfirmation) + hemodynamic/electrolyte/glucose support; 緊急 MRI, full endocrine panel (draw blood first). Multidisciplinary (neuro手術/endocrinology/ophthalmology) — 重症またはprogressive visual loss, altered consciousness → transsphenoidal surgical 減圧 (good outcomeの場合early), stable 〜なしで significant deficit may be managed conservatively; later hormone replacement (hypopituitarism is common).
- 下垂体卒中はどのガイドラインに基づいていますか？
- Pituitary apoplexy (UK pituitary apoplexy consensus; Endotext; StatPearls) · 準拠：UK consensus / Endotext
出典
- Pituitary apoplexy (UK pituitary apoplexy consensus; Endotext; StatPearls)