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Moscona-Nissan A, Sidauy-Adissi J, Hermoso-Mier KX, Glick-Betech SS, Chávez-Vera LDJ, Martinez-Mendoza F, Delgado-Casillas OM, Taniguchi-Ponciano K, Marrero-Rodríguez D, Mercado M. Diagnosis and Treatment of Pituitary Apoplexy, A True Endocrine Emergency. Arch Med Res 2024; 55:103001. [PMID: 38703639 DOI: 10.1016/j.arcmed.2024.103001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/09/2024] [Accepted: 04/23/2024] [Indexed: 05/06/2024]
Abstract
Pituitary apoplexy (PA) is a clinical syndrome resulting from a hemorrhagic infarction of the pituitary gland. It is characterized by the sudden onset of visual disturbances, nausea, vomiting, headache and occasionally, signs of meningeal irritation and an altered mental status. The exact pathogenesis of PA remains to be elucidated, although tumor overgrowth of its blood supply remains the most popular theory. Main risk factors for the development of PA include systemic, iatrogenic, and external factors as well as the presence of an underlying pituitary tumor. The diagnostic approach of PA includes both neuroimaging and evaluation of pituitary secretory function. PA is a potentially life-threatening condition which should be managed with hemodynamic stabilization, correction of electrolyte abnormalities and replacement of hormonal deficiencies. PA treatment should be individualized based on the severity of the clinical picture which may vary widely. Treatment options include conservative management with periodic follow-up or neurosurgical intervention, which should be decided by a multidisciplinary team. We conducted a systematic review of the literature to unveil the frequency of PA predisposing factors, clinical and biochemical presentations, management strategies and outcomes.
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Affiliation(s)
- Alberto Moscona-Nissan
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Jessica Sidauy-Adissi
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Karla Ximena Hermoso-Mier
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Shimon Shlomo Glick-Betech
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Leonel de Jesús Chávez-Vera
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Florencia Martinez-Mendoza
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Oscar Mario Delgado-Casillas
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Keiko Taniguchi-Ponciano
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Daniel Marrero-Rodríguez
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico
| | - Moisés Mercado
- Unidad de Investigación Médica en Enfermedades Endocrinas, Hospital de Especialidades, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social, Mexico City, Mexico.
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Buchta M, Krainz H, Grimm J, Kraus T, Griessenauer CJ, Schwartz C, Ueberschaer MF, Dejaco M, Otto F. Pituitary Apoplexy in Macroadenoma After Minor Surgery: An Unusual Case and Literature Review. Cureus 2024; 16:e57912. [PMID: 38725789 PMCID: PMC11081411 DOI: 10.7759/cureus.57912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2024] [Indexed: 05/12/2024] Open
Abstract
Pituitary apoplexy is a rare and severe complication of pituitary adenoma that may present with new-onset headache, ocular palsy, visual disturbances, life-threatening electrolyte imbalance, and endocrinological disturbances due to pituitary hemorrhage and/or infarction. We report the case of a 58-year-old previously healthy patient who developed isolated mild oculomotor nerve palsy of the left eye following osteosynthesis of a traumatic right distal radius fracture. Initial cerebral magnetic resonance imaging showed a pituitary macroadenoma without characteristic signs of pituitary infarction or hemorrhage. The patient presented to the neurology department on the fifth postoperative day with malaise and fatigue due to pituitary insufficiency, deteriorated rapidly and required intensive care monitoring. Clinical stabilization was achieved through the administration of hydrocortisone, and transsphenoidal resection of the pituitary lesion was performed on the 10th day after acute symptom onset. Histological examination revealed a necrotic pituitary adenoma. Pituitary apoplexy may occur after minor surgery in patients with pituitary adenoma. Clinicians should pay particular attention to laboratory signs of pituitary insufficiency in new-onset oculomotor nerve palsy associated with sellar lesions, as cerebral imaging may miss pituitary apoplexy and therefore delay diagnosis and treatment. In our case, delayed decompressive transsphenoidal resection resulted in the normalization of the oculomotor nerve palsy while the pituitary insufficiency persisted. The potential impact of an earlier surgical intervention on the outcome of pituitary function remains uncertain.
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Affiliation(s)
- Melanie Buchta
- Neurosurgery, Christian Doppler Medical Center, Paracelsus Private Medical University, Salzburg, AUT
| | - Herbert Krainz
- Neurosurgery, Christian Doppler Medical Center, Paracelsus Private Medical University, Salzburg, AUT
| | - Jochen Grimm
- Neuroradiology, Christian Doppler Medical Center, Paracelsus Private Medical University, Salzburg, AUT
| | - Theo Kraus
- Pathology, University Hospital Salzburg, Paracelsus Private Medical University, Salzburg, AUT
| | - Christoph J Griessenauer
- Neurosurgery, Christian Doppler Medical Center, Paracelsus Private Medical University, Salzburg, AUT
| | - Christoph Schwartz
- Neurosurgery, Christian Doppler Medical Center, Paracelsus Private Medical University, Salzburg, AUT
| | - Moritz F Ueberschaer
- Neurosurgery, Christian Doppler Medical Center, Paracelsus Private Medical University, Salzburg, AUT
| | - Martin Dejaco
- Otolaryngology - Head and Neck Surgery, University Hospital Salzburg, Paracelsus Private Medical University, Salzburg, AUT
| | - Ferdinand Otto
- Neurology, Christian Doppler Medical Center, Paracelsus Private Medical University, Salzburg, AUT
- Neurology, Centre for Cognitive Neuroscience, Salzburg, AUT
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Yildiz Y, Lauber A, Char NV, Bozinov O, Neidert MC, Hostettler IC. Subarachnoid hemorrhage due to pituitary adenoma apoplexy-case report and review of the literature. Neurol Sci 2024; 45:997-1005. [PMID: 37872321 DOI: 10.1007/s10072-023-07130-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 10/07/2023] [Indexed: 10/25/2023]
Abstract
Pituitary apoplexy (PA) may be complicated by development of subarachnoid hemorrhage (SAH). We conducted a literature review to evaluate the rate of PA-associated tumor rupture and SAH. We conducted a systematic literature search (PubMed, Web of Science, Medline) for patients with PA-associated SAH and report a case SAH following PA. Suitable articles, case series, and case reports were selected based on predefined criteria following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We reviewed included publications for clinical, radiological, surgical, and histopathological parameters.We present the case of a patient with PA developing extensive SAH whilst on the MRI who underwent delayed transsphenoidal resection. According to our literature review, we found 55 patients with a median age of 46 years; 18 (32.7%) were female. Factors associated with PA-related SAH were hypertension, diabetes mellitus, prior trauma, anticoagulant, and/or antiplatelet therapy. The most common presenting symptoms included severe headache, nausea and/or vomiting, impaired consciousness, and meningeal irritation. Acute onset was described in almost all patients. Twenty-two of the included patients underwent resection. In patients with available outcome, 45.1% had a favorable outcome, 10 (19.6%) had persisting focal neurological deficits, 7 developed cerebral vasospasms (12.7%), and 18 (35.3%) died. Mortality greatly differed between surgically (9.1%) and non-surgically (44.8%) treated patients. PA-associated SAH is a rare condition developing predominantly in males with previously unknown macroadenomas. Timely surgery often prevents aggravation or development of severe neuro-ophthalmological defects and improves clinical outcome.
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Affiliation(s)
- Yesim Yildiz
- Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Arno Lauber
- Department of Neuroradiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Natalia Velez Char
- Department of Neuropathology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Oliver Bozinov
- Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Marian Christoph Neidert
- Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland
| | - Isabel Charlotte Hostettler
- Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
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Alshahrani AM, Al Bshabshe A, Al Shahrani MB. Pituitary Apoplexy After a Major Abdominal Surgery: A Case Report. Cureus 2024; 16:e52966. [PMID: 38406091 PMCID: PMC10894319 DOI: 10.7759/cureus.52966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/27/2024] Open
Abstract
Pituitary apoplexy is a major complication of pituitary adenoma, and the diagnosis might be challenging if the patient presents with signs of meningeal irritation or electrolyte imbalance. It can be fatal if not diagnosed and treated appropriately. Apoplexy is the first clinical presentation in the majority of pituitary adenoma cases. The pathophysiology of pituitary apoplexy involves bleeding and/or ischemia of pituitary enlargement. In this case report, we present a case of pituitary apoplexy that developed after a major abdominal surgery. The patient presented with headache, hypertension, and visual loss. After confirming the diagnosis through a CT scan, the patient underwent a transsphenoidal surgical decompression.
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Affiliation(s)
| | - Ali Al Bshabshe
- Intensive Care Unit, Aseer Central Hospital, Abha, SAU
- Medicine, King Khalid University, Abha, SAU
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Gheorghe AM, Trandafir AI, Stanciu M, Popa FL, Nistor C, Carsote M. Challenges of Pituitary Apoplexy in Pregnancy. J Clin Med 2023; 12:jcm12103416. [PMID: 37240522 DOI: 10.3390/jcm12103416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/02/2023] [Accepted: 05/07/2023] [Indexed: 05/28/2023] Open
Abstract
Our purpose is to provide new insights concerning the challenges of pituitary apoplexy in pregnancy (PAP) and the postpartum period (PAPP). This is a narrative review of the English literature using a PubMed search. The inclusion criteria were clinically relevant original studies (January 2012-December 2022). Overall, we included 35 original studies: 7 observational studies (selected cases on PA) and 28 case reports, including 4 case series (N = 49; PAP/PAPP = 43/6). The characteristics of PAP patients (N = 43) are as follows: maternal age between 21 and 41 (mean of 27.76) years; 21/43 subjects with a presentation during the third trimester (only one case during first trimester); average weak of gestation of 26.38; most females were prim gravidae; 19 (out of 30 patients with available data on delivery) underwent a cesarean section. Headache remains the main clinical feature and is potentially associated with a heterogeneous panel (including visual anomalies, nausea, vomiting, cranial nerve palsies, diabetes insipidus, photophobia, and neck stiffness). Pre-pregnancy medication included dopamine agonists (15/43) and terguride (1/43) in addition to subsequent insulin therapy for gestational diabetes (N = 2) and type 1 diabetes mellitus (N = 1). Overall, 29/43 females received the conservative approach, and 22/43 women had trans-sphenoidal surgery (TSS) (and 10/22 had the initial approach). Furthermore, 18/43 patients had a pituitary adenoma undiagnosed before pregnancy. Most PA-associated tumors were prolactinomas (N = 26/43), with the majority of them (N = 16/26) being larger than 1 cm. A maternal-fetal deadly outcome is reported in a single case. The characteristics of PAPP patients (N = 6) are as follows: mean age at diagnosis of 33 years; 3/6 subjects had PA during their second pregnancy; the timing of PA varied between 5 min and 12 days after delivery; headache was the main clinical element; 5/6 had no underlying pituitary adenoma; 5/6 patients were managed conservatively and 1/6 underwent TSS; pituitary function recovered (N = 3) or led to persistent hypopituitarism (N = 3). In conclusion, PAP represents a rare, life-threatening condition. Headache is the most frequent presentation, and its prompt distinction from other conditions associated with headache, such as preeclampsia and meningitis, is essential. The index of suspicion should be high, especially in patients with additional risk factors such as pre-gestation treatment with dopamine agonists, diabetes mellitus, anticoagulation therapy, or large pituitary tumors. The management is conservative in most cases, and it mainly includes corticosteroid substitution and dopamine agonists. The most frequent surgical indication is neuro-ophthalmological deterioration, although the actual risk of pituitary surgery during pregnancy remains unknown. PAPP is exceptionally reported. To our knowledge, this sample-case series study is the largest of its kind that is meant to increase the awareness to the benefit of the maternal-fetal outcomes from multidisciplinary insights.
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Affiliation(s)
- Ana-Maria Gheorghe
- Department of Endocrinology, "C.I. Parhon" National Institute of Endocrinology, 011683 Bucharest, Romania
| | - Alexandra-Ioana Trandafir
- Department of Endocrinology, Doctoral School of "Carol Davila" University of Medicine and Pharmacy, "C.I. Parhon" National Institute of Endocrinology, 011683 Bucharest, Romania
| | - Mihaela Stanciu
- Department of Endocrinology, Faculty of Medicine, "Lucian Blaga" University of Sibiu, 50169 Sibiu, Romania
| | - Florina Ligia Popa
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, "Lucian Blaga" University of Sibiu, 550169 Sibiu, Romania
| | - Claudiu Nistor
- Department 4-Cardio-Thoracic Pathology, Thoracic Surgery II Discipline, Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy & Thoracic Surgery Department, "Dr. Carol Davila" Central Emergency University Military Hospital, 013058 Bucharest, Romania
| | - Mara Carsote
- Department of Endocrinology, "Carol Davila" University of Medicine and Pharmacy & "C.I. Parhon" National Institute of Endocrinology, 011683 Bucharest, Romania
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Ibrahim B, Mandel M, Ali A, Najera E, Obrzut M, Adada B, Borghei-Razavi H. Pituitary Adenomas: Classification, Clinical Evaluation and Management. Skull Base Surg 2022. [DOI: 10.5772/intechopen.103778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pituitary adenomas are one of the most common brain tumors. They represent approximately 18% of all intracranial, and around 95% of sellar neoplasms. In recent years, our understanding of the pathophysiology and the behavior of these lesions has led to better control and higher curative rates. The treatment decision is largely dependent on type of the adenoma, clinical presentation, and the size of the lesion. In addition, incidental pituitary lesions add uncertainty in the decision-making process, especially for pituitary adenomas that can be medically managed. When surgery is indicated, the endoscopic endonasal transsphenoidal approach is the technique of choice, but open standard craniotomy approaches can also be the option in selected cases. The following chapter will review the classification, clinical presentation, pathophysiology, diagnostic work-up, selection of surgical approach, and treatment complications in pituitary adenomas.
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Tanaka S, Suzuki S, Oishi M, Soeta S, Namiki R, Hara Y. Adrenocorticotropic hormone-producing pituitary adenoma with pituitary apoplexy treated by surgical decompression: a case report. BMC Vet Res 2022; 18:397. [PMID: 36369011 PMCID: PMC9652851 DOI: 10.1186/s12917-022-03502-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Pituitary-dependent hypercortisolism (PDH) is one of the most common endocrine disorders in veterinary medicine. However, there are few reports on pituitary tumor apoplexy (PTA) in dogs and no reports on its surgical intervention in veterinary medicine. Accordingly, the appropriate treatment is unknown. Herein, a case of PDH and PTA in a dog treated surgically is described. Case presentation A mongrel female dog (spayed; age, 8 years and 8 months; weight, 6.1 kg) with persistently elevated alkaline phosphatase underwent adrenocorticotropic hormone (ACTH) stimulation testing (post-stimulation cortisol: 20.5 μg/dL), abdominal ultrasonography (adrenal gland thickness: left, 5.7 mm; right, 8.1 mm), and brain magnetic resonance imaging (MRI) (pituitary-to-brain ratio [PBR], 0.61) at the referral hospital, resulting in a diagnosis of PDH (day 0). On day 9, the dog visited XXXX for the preparation of pituitary surgery to treat PDH. However, on days 10–15, the dog developed a loss of energy and appetite, bloody diarrhea, vomiting, and a decreased level of consciousness. However, on day 16, the dog’s condition recovered. A preoperative MRI scan performed on day 52 (the day of surgery) showed apoplexy in the dorsal pituitary region (PBR, 0.68). Based on the PTA findings, the risks of surgery were described to the owner, and approval was obtained. At the time of trans-sphenoidal surgery, a partial pituitary resection was performed with preservation of the PTA area due to adhesions between the PTA area of the right side of the pituitary and surrounding tissues. The resected pituitary tissue was diagnosed as an ACTH-producing adenoma, with necrotic and hemorrhagic findings. As of day 290, endogenous ACTH and cortisol levels did not exceed the reference range. Conclusions The acute signs that occurred on days 10–15 were most likely caused by PTA. Therefore, when signs similar to those detected in acute hypoadrenocorticism are observed in dogs with PDH, it is necessary to include PTA as a differential diagnosis. Trans-sphenoidal surgery may be effective in PDH-affected dogs that develop PTA, but careful attention should be paid to tissue adhesions secondary to hemorrhage that may occur after PTA.
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Klavansky D, Kellner C, Ghatan S, Nelson S. Preventing Poor Outcomes for Neurosurgical Patients. Semin Neurol 2022; 42:611-625. [PMID: 36427527 DOI: 10.1055/s-0042-1758704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Ensuring that patients with neurosurgical conditions have the best possible outcome requires early diagnosis, monitoring, and interventions to prevent complications and optimize care. Here, we review several neurosurgical conditions and the measures taken to prevent complications and optimize outcomes. We hope that the practical tips provided herein prove helpful in caring for neurosurgical patients.
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Affiliation(s)
- Dana Klavansky
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Christopher Kellner
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Saadi Ghatan
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Sarah Nelson
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, New York
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Donegan D, Erickson D. Revisiting Pituitary Apoplexy. J Endocr Soc 2022; 6:bvac113. [PMID: 35928242 PMCID: PMC9342855 DOI: 10.1210/jendso/bvac113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Indexed: 11/19/2022] Open
Abstract
Abstract
Pituitary apoplexy (PA) is a rare clinical syndrome due to pituitary hemorrhage or infarction. It is characterized by the sudden onset of one or more of the following: severe headache, visual disturbance, nausea/vomiting, and or altered mental status. Most commonly, PA occurs in an underlying pituitary adenoma. The pathophysiology is not fully understood, but it is thought to involve elements of increased metabolic demand and/or compromise to the vasculature of the pituitary or pituitary tumor. Several risk factors have been described. Stabilization of the patient on presentation, replacement of hormonal deficiencies, and reversal of electrolyte abnormalities are the recommended initial steps in the management of patients with PA. Surgical decompression of the mass effect had been the recommended treatment for patients with PA; however, retrospective studies of patients with PA have demonstrated similar outcomes when a conservative approach is applied. This suggests that in highly selected clinical scenarios (mild visual deficit and improving symptoms), conservative management is possible. Further studies, however, are necessary to better stratify patients but are limited by the rarity of the condition and the acuity.
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Affiliation(s)
- Diane Donegan
- Division of Endocrinology, Diabetes and Metabolism, Indiana University , Indianapolis, Indiana 46220 , USA
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic Minnesota , Rochester, Minnesota 55905 , USA
| | - Dana Erickson
- Division of Endocrinology, Diabetes and Metabolism, Mayo Clinic Minnesota , Rochester, Minnesota 55905 , USA
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Surgery for Pituitary Tumor Apoplexy Is Associated with Rapid Headache and Cranial Nerve Improvement. Curr Oncol 2022; 29:4914-4922. [PMID: 35877250 PMCID: PMC9319222 DOI: 10.3390/curroncol29070390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 07/06/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022] Open
Abstract
Pituitary tumor apoplexy (PTA) classically comprises sudden-onset headache, loss of vision, ophthalmoparesis, and decreased consciousness. It typically results from hemorrhage and/or infarction within a pituitary adenoma. Presentation is heterologous, and optimal management is debated. The time course of recovery of cranial nerve deficits (CNDs) and headaches is not well established. In this study, a retrospective series of consecutive patients with PTA managed at a single academic institution over a 22-year period is presented. Headaches at the time of surgery were more severe in the early and subacute surgical cohort and improved significantly within 72 h postoperatively (p < 0.01). At one year, 90% of CNDs affecting cranial nerves (CNs) 3, 4, and 6 had recovered, with no differences between early (<4 d), subacute (4−14 d), and delayed (>14 d) time-to-surgery cohorts. Remarkably, half recovered within three days. In total, 56% of CN2 deficits recovered, with the early surgery cohort including more severe deficits and recovering at a lower rate (p = 0.01). No correlation of time-to-surgery and rapidity of recovery of CNDs was observed (p = 0.65, 0.72). Surgery for PTA is associated with rapid recovery of CNDs in the early, subacute, and delayed time frames, and with rapid headache improvement in the early and subacute time frames in 50% or more of patients.
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Wei IH, Huang CC. Risk of Mental Illnesses in Patients With Hypopituitarism: A Nationwide Population-Based Cohort Study. Psychiatry Investig 2022; 19:418-426. [PMID: 35753680 PMCID: PMC9233955 DOI: 10.30773/pi.2022.0010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 03/27/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE The associations of mental illnesses and hypopituitarism have been reported. But, pituitary disorders are rare. The epidemiological studies have rarely addressed these associations between pituitary disorder and mental illnesses. Until now, no cohort study has been conducted to investigate the association. METHODS We performed a nationwide, retrospective cohort study using the Taiwanese National Health Insurance Program dataset to analyze this relationship. In total, 1,194 patients diagnosed with hypopituitarism between 2000 and 2013 were identified. For the control group, 4,776 individuals without hypopituitarism and psychotic diseases were matched (1:4) according to age, sex, and index date. A Cox proportional hazards model was used to determine the adjusted hazard ratio (aHR). RESULTS Patients with hypopituitarism had a significantly higher risk of incident depression and anxiety disorders than those without hypopituitarism. The aHRs of depressive and anxiety disorders were 2.98 and 1.67, respectively, for the hypopituitarism cohort. Furthermore, the risk of both hypopituitarism-associated depressive and anxiety disorders was significantly high in female subjects and subjects aged ≥18 years. A statistically significant increase was not observed in the risk of bipolar disorders, dementia, or schizophrenia in the hypopituitarism group compared with the control group. CONCLUSION Although psychiatric morbidities were uncommon for the hypopituitarism cohort, the risk of developing depressive and anxiety disorders was significantly higher in those with hypopituitarism than in those without hypopituitarism.
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Affiliation(s)
- I-Hua Wei
- Department of Anatomy, China Medical University, Taichung, Taiwan
| | - Chih-Chia Huang
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan.,Department of Psychiatry, China Medical University, Taichung, Taiwan.,Program in Translational Medicine, National Chung Hsing University, Taichung, Taiwan
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Puglisi V, Morini E, Biasini F, Vinciguerra L, Lanza G, Bramanti P. Neurological Presentation of Giant Pituitary Tumour Apoplexy: Case Report and Literature Review of a Rare but Life-Threatening Condition. J Clin Med 2022; 11:jcm11061581. [PMID: 35329907 PMCID: PMC8953299 DOI: 10.3390/jcm11061581] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/24/2022] [Accepted: 03/11/2022] [Indexed: 02/07/2023] Open
Abstract
Background: Giant pituitary adenomas are benign intracranial tumours with a diameter ≥4 cm. Even if hormonally non-functional, they may still cause local extension, leading to symptoms that include mostly gland dysfunction, mass effects, and, much less frequently, apoplexy due to haemorrhage or infarction. Neurological presentation of giant pituitary tumour apoplexy is even more rare and has not been systematically reviewed. Case Presentation: An 81-year-old woman was admitted to the Emergency Department because of acute onset headache, bilateral visual deficit, and altered consciousness. Computed tomography showed a giant mass lesion (>5.5 cm diameter) expanding upward to the suprasellar cistern, optic chiasm, and third ventricle, over-running the sphenoid sinus, and with lateral invasion of the cavernous sinus. Laboratory investigations revealed central adrenal and hypothyroidism insufficiency, while magnetic resonance imaging confirmed a voluminous suprasellar tumour (~6 cm diameter), with signs of pituitary tumour apoplexy. Neurological manifestations and gland-related deficits improved after hormonal replacement therapy with a high dose of intravenous hydrocortisone, followed by oral hydrocortisone and levo-thyroxine. The patient declined surgical treatment and follow-up visit. Conclusions: Giant pituitary tumour apoplexy is a rare but potentially life-threatening condition. Prompt diagnosis and multidisciplinary management may allow a remarkable clinical improvement, as seen in this case.
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Affiliation(s)
- Valentina Puglisi
- Department of Neurology and Stroke Unit, Istituti Ospitalieri, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy; (V.P.); (L.V.)
| | - Elisabetta Morini
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy; (E.M.); (P.B.)
| | - Fiammetta Biasini
- Unit of Neurology and Neuromuscular Diseases, Policlinico University Hospital “G. Martino”, Via Consolare Valeria 1-2, 98124 Messina, Italy;
| | - Luisa Vinciguerra
- Department of Neurology and Stroke Unit, Istituti Ospitalieri, ASST Cremona, Viale Concordia 1, 26100 Cremona, Italy; (V.P.); (L.V.)
| | - Giuseppe Lanza
- Department of Surgery and Medical-Surgical Specialties, University of Catania, Via Santa Sofia 78, 95123 Catania, Italy
- Clinical Neurophysiology Research Unit, Oasi Research Institute-IRCCS, Via Conte Ruggero 73, 94018 Troina, Italy
- Correspondence: ; Tel.: +39-095-3782448
| | - Placido Bramanti
- IRCCS Centro Neurolesi “Bonino-Pulejo”, Via Provinciale Palermo, Contrada Casazza, 98124 Messina, Italy; (E.M.); (P.B.)
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13
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Drissi Oudghiri M, Motaib I, Elamari S, Laidi S, Chadli A. Pituitary Apoplexy in Geriatric Patients: A Report of Four Cases. Cureus 2021; 13:e20318. [PMID: 35028217 PMCID: PMC8748001 DOI: 10.7759/cureus.20318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2021] [Indexed: 11/18/2022] Open
Abstract
Pituitary apoplexy (PA) is a rare clinical syndrome related to abrupt hemorrhage and/or infarction of the pituitary gland, usually occurring in patients with preexisting pituitary disease. It is an endocrine emergency requiring rapid diagnosis and appropriate management. This is a literature review and a retrospective study reporting the observation of four patients that have suffered from pituitary macroadenomas. These observations illustrate the particularities of this pathology in the elderly. The symptoms may be truncated and lead to a late diagnosis with its repercussions on management, without forgetting the particularity of the fragile and multisystemic terrain, which may contraindicate the usual surgical treatment. A rapid diagnosis and appropriate management can limit the occurrence of irreversible complications.
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Sowka JW, Wu TH. Case Report: Polyneuropathy Pituitary Apoplexy with Normal Perimetry and Initially Normal Neuroimaging. Optom Vis Sci 2021; 98:1139-1142. [PMID: 34629437 DOI: 10.1097/opx.0000000000001786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
SIGNIFICANCE Pituitary apoplexy is a syndrome with a varied appearance, which carries a significant risk of morbidity and mortality. It is important to recognize the potential numerous symptoms and clinical findings, urgently investigate with the proper neuroimaging tests, and coordinate care with the appropriate specialists without delay. PURPOSE This study aimed to describe a patient with worsening headache and ophthalmoparesis attributable to pituitary apoplexy who initially had reportedly a normal neuroimaging result and were diagnosed with migraine. CASE REPORT A 39-year-old Hispanic man with a history of migraine developed a new and worsening headache. He presented to a hospital emergency department where he underwent a non-contrast-enhanced computed tomography and MRI, whose results were subsequently interpreted as normal. His headache was attributed to migraine, and he was medicated as such and discharged. Three days later, he developed horizontal and vertical diplopia and sought a second opinion. His visual acuity and visual fields were normal. He manifested a right pupil-sparing, external partial cranial nerve III palsy and concurrent right sixth nerve palsy. He also complained of worsening headache and lethargy. He was immediately referred for contrast-enhanced MRI and magnetic resonance angiography with suspicion of pituitary apoplexy. Subsequent imaging revealed a hemorrhagic pituitary macroadenoma consistent with pituitary apoplexy that was expanding laterally into the right cavernous sinus. He underwent immediate neurosurgical surgical repair. CONCLUSIONS New or worsening headache with signs and symptoms of hypopituitarism should immediately be investigated for pituitary apoplexy. Other possible findings include involvement of cranial nerves III through VI because of cavernous sinus involvement and visual deficits if the optic chiasm or intracranial portion of the optic nerve is involved. However, growth may be lateral, and no visual deficits may be found, as in this case. Multiple concurrent cranial neuropathies should increase suspicion for cavernous sinus involvement.
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Affiliation(s)
| | - Tsung-Hao Wu
- Marciano Family Optometric, West Palm Beach, Florida
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Komić L, Kruljac I, Mirošević G, Gaćina P, Pećina HI, Čerina V, Gajski D, Blaslov K, Rotim K, Vrkljan M. SPONTANEOUS RESOLUTION OF A NONFUNCTIONING PITUITARY ADENOMA OVER ONE-MONTH PERIOD: A CASE REPORT. Acta Clin Croat 2021; 60:317-322. [PMID: 34744285 PMCID: PMC8564843 DOI: 10.20471/acc.2021.60.02.21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 04/12/2021] [Indexed: 11/24/2022] Open
Abstract
Spontaneous resolution of nonfunctioning pituitary adenoma after hemorrhagic apoplexy is a rare clinical entity of unknown etiology and is defined as disappearance of a tumor without any specific treatment. Here we present a 54-year-old male patient who presented with acute onset of severe headache, vomiting, photophobia, and sonophobia. He was referred to brain computed tomography, which showed a 16x12x16 mm tumor mass located in the sellar region with signs of hemorrhage. Endocrinologic evaluation was consistent with under-function of pituitary gonadotropic cells. Magnetic resonance imaging (MRI) performed ten days later was consistent with hemorrhagic apoplexy of the pituitary adenoma. The patient’s symptoms resolved after conservative treatment with dexamethasone, but he was scheduled for elective pituitary surgery. Preoperative MRI was performed one month after the first one and disclosed normal pituitary gland without any signs of adenoma. Our case is remarkable due to the fact that spontaneous remission of pituitary adenoma occurred within the first month, which is the shortest interval reported to date. Our case highlights the importance of conservative therapy as the first-line treatment for pituitary apoplexy in the absence of neurological impairment, since spontaneous remission may occur in a short time interval.
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Affiliation(s)
| | - Ivan Kruljac
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Gorana Mirošević
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Petar Gaćina
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Hrvoje Ivan Pećina
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Vatroslav Čerina
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Domagoj Gajski
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Kristina Blaslov
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Krešimir Rotim
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
| | - Milan Vrkljan
- 1University of Split, School of Medicine, Split, Croatia; 2Mladen Sekso Department of Endocrinology, Diabetes and Metabolic Diseases, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 3Department of Internal Medicine, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 4University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 5Department of Radiology, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 6Department of Neurosurgery, Sestre milosrdnice University Hospital Centre, Zagreb, Croatia; 7University of Applied Health Sciences, Zagreb, Croatia; 8Josip Juraj Strossmayer University of Osijek, Faculty of Medicine, Osijek, Croatia; 9University of Zagreb, School of Medicine, Zagreb, Croatia
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Abstract
Cancer and cancer therapies have the potential to affect the nervous system in a host of different ways. Cerebral edema, increased intracranial pressure, cerebrovascular events, status epilepticus, and epidural spinal cord compression are among those most often presenting as emergencies. Neurologic side-effects of cancer therapies are often mild, but occasionally result in serious illness. Immunotherapies cause autoimmune-related neurologic side-effects that are generally responsive to immunosuppressive therapies. Emergency management of neuro-oncologic problems benefits from early identification and close collaboration among interdisciplinary team members and patients or surrogate decision-makers.
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Affiliation(s)
- Zachary D Threlkeld
- Division of Neurocritical Care, Department of Neurology, Stanford University School of Medicine, 300 Pasteur Drive MC 5778, Stanford, CA 94305, USA
| | - Brian J Scott
- Division of Neurohospitalist Medicine, Department of Neurology, Stanford University School of Medicine, 453 Quarry Rd, 2nd Floor, Stanford, CA 94305, USA.
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17
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Abstract
Neuro-ophthalmic emergencies include optic nerve, central visual pathway, and ocular motility disorders that, if not identified and treated promptly, may lead to permanent vision loss, other significant morbidity, or mortality. This article provides a framework for approaching patients with neuro-ophthalmic symptoms and reviews the presentation, evaluation, and treatment of select emergent conditions that can cause them. Emergent causes of blurry vision, transient vision loss, papilledema, and diplopia, including giant cell arteritis, cardioembolic disease, and aggressive infection, are discussed.
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18
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Diffusion Tensor Imaging Tractography Detecting Isolated Oculomotor Paralysis Caused by Pituitary Apoplexy. Neurologist 2020; 25:157-161. [PMID: 33181723 DOI: 10.1097/nrl.0000000000000290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
OBJECTIVES Pituitary apoplexy (PA)-induced oculomotor palsy, although rare, can be caused by compression on the lateral wall of the cavernous sinus. This study aimed to visualize PA-induced oculomotor nerve damage using diffusion tensor imaging (DTI) tractography. MATERIALS AND METHODS We enrolled 5 patients with PA-induced isolated oculomotor palsy (patient group) and 10 healthy participants (control group); all underwent DTI tractography preoperatively. Fractional anisotropy (FA) and mean diffusion (MD) values of the cisternal portion of the bilateral oculomotor nerve were measured. DTI tractography was repeated after the recovery of oculomotor palsy. RESULTS While no statistical difference was observed in FA and MD values of the bilateral oculomotor nerve in the control group (P>0.05), the oculomotor nerve on the affected side was disrupted in the patient group, with a statistical difference in FA and MD values of the bilateral oculomotor nerve (P<0.01). After the recovery of oculomotor palsy, the FA value of the oculomotor nerve on the affected side increased, whereas the MD value decreased (P<0.01). Meanwhile, no significant difference was observed in FA and MD values of the bilateral oculomotor nerve (P>0.05). DTI tractography of the oculomotor nerve on the affected side revealed restoration of integrity. Furthermore, the symptoms of oculomotor palsy improved in all patients 7 days postoperatively. CONCLUSION DTI tractography could be a helpful adjunct to the standard clinical and paraclinical ophthalmoplegia examinations in patients with PA; thus, this study establishes the feasibility of DTI tractography in this specific clinical setting.
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19
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Benea SN, Lazar M, Hristea A, Hrisca RM, Niculae CM, Moroti RV. CENTRAL HYPOTHYROIDISM IN SEVERE SEPSIS. ACTA ENDOCRINOLOGICA-BUCHAREST 2020; 15:372-377. [PMID: 32010358 DOI: 10.4183/aeb.2019.372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Objective A partial or complete deficiency of hormone secretion by pituitary gland (hypopituitarism) is commonly seen after a pituitary apoplexy caused by an infarction of a pituitary adenoma or pituitary hyperplasia (as in Sheehan's syndrome). Hypopituitarism may also follow surgery, when hypovolemia, anticoagulation, fat/air/bone marrow microemboli can provoke a pituitary infarction/hemorrhage. Other causes of abrupt hypophyseal hypoperfusion, as hypovolemia during a septic shock, could also contribute. In the last mentioned situation, due to the complex endocrine-immune interrelation, sepsis could be masked and improperly managed. Case report We report a case of a 72 years-old Caucasian woman, previously healthy, who underwent an orthopedic surgery for a femoral fracture. This event apparently triggered a central-origin hypothyroidism, misinterpreted as "post-surgical psychosis", which, in turn, masked a symptomatology of a subsequent severe sepsis. The patient was admitted in the infectious diseases department with a severe gut-origin sepsis, needing surgery and long course antibiotics. The pituitary insufficiency was reversed. Conclusion Pituitary apoplexy is an uncommon but potentially life-threatening disease, and could be precipitated by successive events - in our case an orthopedic surgery and a subsequent severe sepsis. It needs recognizing (has intrinsic severity and could mask other serious conditions), treat and monitor (could progress and/or reverse).
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Affiliation(s)
- S N Benea
- "Prof. Dr. Matei Bals" National Institute of Infectious Diseases, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - M Lazar
- "Prof. Dr. Matei Bals" National Institute of Infectious Diseases, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - A Hristea
- "Prof. Dr. Matei Bals" National Institute of Infectious Diseases, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
| | - R M Hrisca
- "Carol Davila" Military Emergency University Hospital, Bucharest, Romania
| | - C M Niculae
- "Prof. Dr. Matei Bals" National Institute of Infectious Diseases, Bucharest, Romania
| | - R V Moroti
- "Prof. Dr. Matei Bals" National Institute of Infectious Diseases, Bucharest, Romania.,"Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania
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20
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Pangal DJ, Chesney K, Memel Z, Bonney PA, Strickland BA, Carmichael J, Shiroishi M, Jason Liu CS, Zada G. Pituitary Apoplexy Case Series: Outcomes After Endoscopic Endonasal Transsphenoidal Surgery at a Single Tertiary Center. World Neurosurg 2020; 137:e366-e372. [PMID: 32032792 DOI: 10.1016/j.wneu.2020.01.204] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 01/25/2020] [Accepted: 01/27/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The management of pituitary apoplexy, caused by acute hemorrhage and/or infarction of a pituitary adenoma, is debated. OBJECTIVE To analyze clinical characteristics of patients undergoing endoscopic endonasal approaches (EEAs) for pituitary apoplexy. METHODS A retrospective review of patients at our institution from 2012 to 2018 undergoing EEA for pituitary apoplexy diagnosed clinically and with imaging/pathologic findings. Analysis included demographics, symptoms, neuroendocrine deficits, neuroimaging, complications, symptom resolution, and follow-up details. RESULTS Fifty patients (mean age, 53 years) were included. Preoperative symptoms included headache (86%), vision loss (62%), and cranial nerve paresis (40%). Mean tumor diameter was 2.7 cm and extrasellar extension was observed in 96% of tumors. Twenty-eight tumors were hemorrhagic (76%), 24 were necrotic (65%), and 13 (35%) had both features. Magnetic resonance imaging showed gross total resection in 58% of patients. Headache and vision loss improved in 87% and 86% of presenting patients. Cranial nerve paresis resolved in 72% of patients, partially improved in 11%, and remained unchanged in 17%. There were no deaths or carotid artery injuries. Surgical complications included postoperative cerebrospinal fluid leak (n = 4, 8%), epistaxis (n = 2, 4%), postoperative abscess (n = 1, 2%), and transient postoperative vision loss requiring reoperation (n = 1, 4%). Endocrinopathies improved in 21% of patients and panhypopituitarism persisted in 48% and developed in 6% of patients. Mean follow-up time was 26 months; 2 patients experienced recurrence. CONCLUSIONS EEA for pituitary apoplexy is effective in rapidly improving headache and visual symptoms. Although neuro-ophthalmic deficits often improve over time, panhypopituitarism persists in most patients after surgical resection.
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Affiliation(s)
- Dhiraj J Pangal
- Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Kelsi Chesney
- Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Zoe Memel
- Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Phillip A Bonney
- Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Ben A Strickland
- Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - John Carmichael
- Division of Endocrinology, Department of Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, USA; USC Pituitary Center, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Mark Shiroishi
- Department of Radiology, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Chia-Shang Jason Liu
- Department of Radiology, Keck School of Medicine of University of Southern California, Los Angeles, California, USA
| | - Gabriel Zada
- Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, USA; USC Pituitary Center, Keck School of Medicine of University of Southern California, Los Angeles, California, USA.
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Abstract
PURPOSE OF REVIEW Pituitary apoplexy (PA) occurs in the setting of an infarction and/or hemorrhage of a pre-existing adenoma. The most common presenting symptom is a severe, sudden onset headache. However, the characteristics of headache in the setting of PA are varied and can sometimes mimic primary headache disorders. The purpose of this article is to review the various presentations of headache in PA. We also outline treatment options for persistent headaches following PA. RECENT FINDINGS A recent retrospective review of patients undergoing transsphenoidal resection of sellar lesions, including PA, found that gross total resection and short duration of preoperative headache were predictors of improvement in headaches postoperatively. This strengthens the importance of timely recognition of PA as potential etiology of headache. The most common presentation of PA is thunderclap headache; however, several other primary HA disorders have been described including status migraine, SUNCT, and paroxysmal hemicrania.
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Affiliation(s)
- Himanshu Suri
- Department of Neurology, Georgetown University Medical Center, Washington, DC, USA
| | - Carrie Dougherty
- Department of Neurology, MedStar Georgetown University Hospital, 3800 Reservoir Road NW, Washington, DC, 20007, USA.
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Harju T, Alanko J, Numminen J. Pituitary apoplexy following endoscopic nasal surgery: A case report. SAGE Open Med Case Rep 2019; 7:2050313X19855867. [PMID: 31217974 PMCID: PMC6558528 DOI: 10.1177/2050313x19855867] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 05/15/2019] [Indexed: 11/24/2022] Open
Abstract
Pituitary apoplexy develops as a consequence of acute haemorrhage and/or
infarction in a pre-existing pituitary adenoma. Typical symptoms include sudden
onset headache, visual acuity/field defects, and ocular palsies. We report a
male patient with a known pituitary macroadenoma who underwent a right-sided
endoscopic nasal surgery. Preoperatively, thickening of sphenoid mucosa was seen
in computed tomography and magnetic resonance imaging. The patient developed
pituitary apoplexy postoperatively. The presented report indicates that in
patients with a pituitary adenoma, nasal surgery – like any other kind of
surgery – is a possible precipitating factor for pituitary apoplexy. Isolated
thickening of sphenoid mucosa is associated with pituitary apoplexy. It may also
precede an apoplectic event.
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Affiliation(s)
- Teemu Harju
- Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland
| | - Juha Alanko
- Valkeakoski District Hospital, Valkeakoski, Finland
| | - Jura Numminen
- Department of Otorhinolaryngology, Tampere University Hospital, Tampere, Finland
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23
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Wang WF, Yang LH, Han L, Li MJ, Xiao JQ. Efficacy of transsphenoidal surgery for pituitary tumor: A protocol for systematic review. Medicine (Baltimore) 2019; 98:e14434. [PMID: 30732203 PMCID: PMC6380780 DOI: 10.1097/md.0000000000014434] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND This systematic review aims to assess the efficacy and safety of transsphenoidal surgery (TPS) for patients with a pituitary tumor (PT). METHODS We will retrieve the following electronic databases for randomized controlled trials or case-control studies to assess the effect and safety of TPS for PT: Cochrane Library, EMBASE, MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, Allied and Complementary Medicine Database, and Chinese Biomedical Literature Database. Each database will be retrieved from the inception to December 20, 2018. The entire process consists of the study selection, data collection, methodology quality assessment, data pooled, and meta-analysis performance. The methodology quality will be assessed by using Cochrane risk of bias tool. The data pooled and meta-analysis will be conducted by using RevMan 5.3 software. RESULTS This study will evaluate the efficacy and safety of TPS for PT. The primary outcome includes total tumor resection rate. The secondary outcomes consist of quality of life, total tumor resection rate, postoperative complication rate, and the rate of functional tumor hormone levels. CONCLUSION The expected results may provide up-to-date evidence of TPS for the treatment of PT. PROSPERO REGISTRATION NUMBER PROSPERO CRD42018120194.
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Affiliation(s)
| | - Lin-Hong Yang
- Department of Otorhinolaryngology, First Affiliated Hospital of Jiamusi University
| | - Lin Han
- Department of Ear-Nose-Throat, The 163th Hospital of the People's Liberation Army Joint Service Support Force, Jiamusi
| | | | - Jian-Qi Xiao
- Department of Neurosurgery, The First Hospital of Qiqihar City, Qiqihar, China
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24
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Grossman S, Rothstein A, Conway J, Gurin L, Galetta S. Clinical Reasoning: A 41-year-old man with thunderclap headache. Neurology 2018; 91:e87-e91. [DOI: 10.1212/wnl.0000000000005738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Salehi N, Firek A, Munir I. Pituitary Apoplexy Presenting as Ophthalmoplegia and Altered Level of Consciousness without Headache. Case Rep Endocrinol 2018; 2018:7124364. [PMID: 29854489 PMCID: PMC5966706 DOI: 10.1155/2018/7124364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 03/28/2018] [Indexed: 11/18/2022] Open
Abstract
Background. Pituitary apoplexy (PA) is a clinical syndrome caused by acute ischemic infarction or hemorrhage of the pituitary gland. The typical clinical presentation of PA includes acute onset of severe headache, visual disturbance, cranial nerve palsy, and altered level of consciousness. Case Report. A 78-year-old man presented to the emergency department with one-day history of ptosis and diplopia and an acute-onset episode of altered level of consciousness which was resolving. He denied having headache, nausea, or vomiting. Physical examination revealed third-cranial nerve palsy and fourth-cranial nerve palsy both on the right side. Noncontrast computed tomography (CT) scan of the head was unremarkable. Brain magnetic resonance imaging (MRI) showed a pituitary mass with hemorrhage (apoplexy) and extension to the right cavernous sinus. The patient developed another episode of altered level of consciousness in the hospital. Transsphenoidal resection of the tumor was done which resulted in complete recovery of the ophthalmoplegia and mental status. Conclusion. Pituitary apoplexy can present with ophthalmoplegia and altered level of consciousness without having headache, nausea, or vomiting. A CT scan of the head could be negative for hemorrhage. A high index of suspicion is needed for early diagnosis and timely management of pituitary apoplexy.
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Affiliation(s)
- Nooshin Salehi
- Department of Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Anthony Firek
- Division of Endocrinology, Department of Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA
| | - Iqbal Munir
- Division of Endocrinology, Department of Medicine, Riverside University Health System Medical Center, Moreno Valley, CA, USA
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Rahman SH, Chittibonia P, Quezado M, Patronas N, Stratakis CA, Lodish MB. Delayed Diagnosis of Cushing's Disease in a Pediatric Patient due to Apparent Remission from Spontaneous Apoplexy. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY CASE REPORTS 2017; 2:30-34. [PMID: 28848696 DOI: 10.1016/j.jecr.2016.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report here a pediatric patient whose Cushing's Disease was diagnosed late because of her cyclical presentation, presumably due to subclinical pituitary apoplexy. Starting at age 8, she presented with observable signs of Cushing's but was not clinically assessed for Cushing's Syndrome until the age of 15. Initial tests at age 15 were consistent with Cushing's Disease, however, the patient presented with spontaneous remission of hypercortisolemia just a few short months later. Her cushingoid features never subsided, and at age 17, her MRI showed a partially empty sella; this finding of an empty sella contributed evidence to our suspicion of asymptomatic apoplexy, especially since the patient never reported an episode of acute headache. Pituitary apoplexy in corticotroph adenomas is very uncommon, but even more rare in microadenomas, making this case very unusual. Lost to follow-up, she was not reevaluated for Cushing's Disease until age 25, and her laboratory tests were consistent with an adrenocorticotrophic-dependent pituitary tumor; Pituitary magnetic resonance imaging revealed a 9 mm X 6 mm X 8 mm mass projecting on the superior aspect of pituitary and abutting the wall of the right cavernous sinus. The patient had a transsphenoidal surgery to remove the microadenoma and is planned to undergo radiation therapy. To the best of our knowledge, this is the first report of subclinical apoplexy of a microadenoma in a pediatric patient with Cushing's Disease. It brings to light the importance of long term follow up for pediatric patients presenting with clinical symptoms of Cushing's Syndrome.
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Affiliation(s)
- Sara H Rahman
- Clinical Center of the National Institutes of Health (NIH) 10 Center Dr, Bethesda, MD 20814.,Frank H. Netter SOM, Quinnipiac University
| | - Prashant Chittibonia
- Clinical Center of the National Institutes of Health (NIH) 10 Center Dr, Bethesda, MD 20814
| | - Martha Quezado
- Clinical Center of the National Institutes of Health (NIH) 10 Center Dr, Bethesda, MD 20814
| | - Nicholas Patronas
- Clinical Center of the National Institutes of Health (NIH) 10 Center Dr, Bethesda, MD 20814
| | | | - Maya B Lodish
- Clinical Center of the National Institutes of Health (NIH) 10 Center Dr, Bethesda, MD 20814
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Ohara N, Yoneoka Y, Seki Y, Akiyama K, Arita M, Ohashi K, Suzuki K, Takada T. Acute hypopituitarism associated with periorbital swelling and cardiac dysfunction in a patient with pituitary tumor apoplexy: a case report. J Med Case Rep 2017; 11:235. [PMID: 28835258 PMCID: PMC5569541 DOI: 10.1186/s13256-017-1371-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 06/28/2017] [Indexed: 11/28/2022] Open
Abstract
Background Pituitary tumor apoplexy is a rare clinical syndrome caused by acute hemorrhage or infarction in a preexisting pituitary adenoma. It typically manifests as an acute episode of headache, visual disturbance, mental status changes, cranial nerve palsy, and endocrine pituitary dysfunction. However, not all patients present with classical symptoms, so it is pertinent to appreciate the clinical spectrum of pituitary tumor apoplexy presentation. We report an unusual case of a patient with pituitary tumor apoplexy who presented with periorbital edema associated with hypopituitarism. Case presentation An 83-year-old Japanese man developed acute anterior hypopituitarism; he showed anorexia, fatigue, lethargy, severe bilateral periorbital edema, and mild cardiac dysfunction in the absence of headache, visual disturbance, altered mental status, and cranial nerve palsy. Magnetic resonance imaging showed a 2.5-cm pituitary tumor containing a mixed pattern of solid and liquid components indicating pituitary tumor apoplexy due to hemorrhage in a preexisting pituitary adenoma. Replacement therapy with oral hydrocortisone and levothyroxine relieved his symptoms of central adrenal insufficiency, central hypothyroidism, periorbital edema, and cardiac dysfunction. Conclusions Common causes of periorbital edema include infections, inflammation, trauma, allergy, kidney or cardiac dysfunction, and endocrine disorders such as primary hypothyroidism. In the present case, the patient’s acute central hypothyroidism was probably involved in the development of both periorbital edema and cardiac dysfunction. The present case highlights the need for physicians to consider periorbital edema as an unusual predominant manifestation of pituitary tumor apoplexy.
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Affiliation(s)
- Nobumasa Ohara
- Department of Endocrinology and Metabolism, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, 4132 Urasa, Minamiuonuma, Niigata, 949-7302, Japan.
| | - Yuichiro Yoneoka
- Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Yasuhiro Seki
- Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Katsuhiko Akiyama
- Department of Neurosurgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Masataka Arita
- Department of Cardioavascular Medicine, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kazumasa Ohashi
- Department of Respiratory Medicine, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Kazuo Suzuki
- Department of Respiratory Medicine, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
| | - Toshinori Takada
- Department of Respiratory Medicine, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Japan
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Shabas D, Sheikh HU, Gilad R. Pituitary Apoplexy Presenting as Status Migrainosus. Headache 2017; 57:641-642. [PMID: 28181226 DOI: 10.1111/head.13046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2017] [Indexed: 10/20/2022]
Affiliation(s)
- Debra Shabas
- Department of Neurology, Mount Sinai Downtown, New York, NY, USA
| | - Huma U Sheikh
- Department of Neurology, Mount Sinai Downtown, New York, NY, USA
| | - Ronit Gilad
- Department of Neurosurgery, Mount Sinai Downtown, New York, NY, USA
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Abstract
Patients with brain tumors and systemic malignancies are subject to diverse neurologic complications that require urgent evaluation and treatment. These neurologic conditions are commonly due to the tumor's direct effects on the nervous system, such as cerebral edema, increased intracranial pressure, seizures, spinal cord compression, and leptomeningeal metastases. In addition, neurologic complications can develop as a result of thrombocytopenia, coagulopathy, hyperviscosity syndromes, infection, immune-related disorders, and adverse effects of treatment. Patients may present with typical disease syndromes. However, it is not uncommon for patients to have more subtle, nonlocalizing manifestations, such as alteration of mental status, that could be attributed to other systemic, nonneurologic complications. Furthermore, neurologic complications are at times the initial manifestations of an undiagnosed malignancy. Therefore a high index of suspicion is essential for rapid assessment and management. Timely intervention may prolong survival and improve quality of life. In this chapter, we will discuss the common neuro-oncologic emergencies, including epidemiology, pathophysiology, clinical presentation, diagnosis, and treatment.
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Affiliation(s)
- J T Jo
- Neuro-Oncology Center, University of Virginia, Charlottesville, VA, USA
| | - D Schiff
- Neuro-Oncology Center, University of Virginia, Charlottesville, VA, USA.
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Zhang RC, Mu YF, Dong J, Lin XQ, Geng DQ. Complex effects of apoplexy secondary to pituitary adenoma. Rev Neurosci 2017; 28:59-64. [PMID: 27802176 DOI: 10.1515/revneuro-2016-0013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/15/2016] [Indexed: 11/15/2022]
Abstract
AbstractPituitary adenoma apoplexy is a well-known clinical syndrome induced by insulin infusion, cardiac surgery, trauma, and hypothalamic releasing factors. Pituitary apoplexy can cause secondary cerebral infarct and internal carotid artery occlusion. With blockade of tumor perfusion, apoplexy triggers a sudden onset of headache, visual impairment, cranial nerve palsy, disturbances of consciousness, eyelid ptosis, and hemiparesis. However, pituitary adenoma cells with high metabolic demand cannot survive with deficient blood supply and glucose concentrations. Moreover, a number of case reports have shown that spontaneous remission of syndromes, such as acromegaly, may be caused by pituitary adenoma after apoplexy. Therefore, understanding mechanism that underlies the balance between pituitary adenoma apoplexy and subsequent spontaneous remission of syndromes may suggest new approaches for treatment of pituitary adenoma apoplexy.
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Affiliation(s)
- Rui-Cheng Zhang
- 1Center of Clinical Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu, China
| | - Ying-Feng Mu
- 2Department of Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu, China
| | - Jing Dong
- 1Center of Clinical Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu, China
| | - Xiao-Qian Lin
- 1Center of Clinical Neurology, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221002, Jiangsu, China
| | - De-Qin Geng
- 3Center of Clinical Neurology, Affiliated Hospital of Xuzhou Medical University, 99 West Huai-hai Road, Xuzhou 221002, Jiangsu, China
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Acute Hemorrhagic Apoplectic Pituitary Adenoma: Endoscopic Management, Surgical Outcomes, and Complications. J Craniofac Surg 2016; 26:e510-5. [PMID: 26335327 PMCID: PMC4568893 DOI: 10.1097/scs.0000000000002026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To assess safety and effectiveness of endoscopic transsphenoidal surgery (ETS) for acute hemorrhagic apoplectic pituitary adenoma. METHODS Eighty nine patients with hemorrhagic apoplectic pituitary tumor undergoing endoscopic transsphenoidal surgery were included into a retrospective chart of this study. Charts were reviewed for patient age, sex, presentation, lesion size, surgical procedure, extent of resection, clinical outcome, and surgical complications. RESULTS Seventy eight (87.7%) patients achieved total resection, 9 (10.1%) had subtotal resection, and 2 (2.2%) patients had partial resection; no patient experienced insufficient resection. After surgery, 65 (90.3%) of 72 patients who had visual acuity deterioration preoperatively normalized and improved significantly; the rate for remission of visual field was 87.7%. All other acute symptoms, such as severe headache, nausea, vomiting, alteration of mental status, and loss of consciousness, vanished postoperatively. Twenty eight (90.4%) of 31 patients with active secreting adenoma had hormonal remission based on endocrinological evaluation. Three (3.4%) patients incurred CSF leakage which was managed with lumbar drainage. Nine (10.1%) patients incurred transient DI postoperatively, and 2 (2.2%) of them developed permanent DI. Seven (7.9%) patients developed hypopituitarism which was treated with replacement therapy of hormone. One (1.1%) experienced craniotomy for intracranial hemorrhage and died from severe surgical complications postoperatively. There were no patients of meningitis or carotid artery injury. CONCLUSION Early detection and emergent endoscopic transsphenoidal surgery provided a safe and effective surgical option for hemorrhagic apoplectic pituitary tumor with a low morbidity and mortality.
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Albani A, Ferraù F, Angileri FF, Esposito F, Granata F, Ferreri F, Cannavò S. Multidisciplinary Management of Pituitary Apoplexy. Int J Endocrinol 2016; 2016:7951536. [PMID: 28074095 PMCID: PMC5198093 DOI: 10.1155/2016/7951536] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2016] [Revised: 10/19/2016] [Accepted: 11/06/2016] [Indexed: 11/17/2022] Open
Abstract
Pituitary apoplexy is a rare clinical syndrome due to ischemic or haemorrhagic necrosis of the pituitary gland which complicates 2-12% of pituitary tumours, especially nonfunctioning adenomas. In many cases, it results in severe neurological, ophthalmological, and endocrinological consequences and may require prompt surgical decompression. Pituitary apoplexy represents a rare medical emergency that necessitates a multidisciplinary approach. Modalities of treatment and times of intervention are still largely debated. Therefore, the management of patients with pituitary apoplexy is often empirically individualized and clinical outcome is inevitably related to the multidisciplinary team's skills and experience. This review aims to highlight the importance of a multidisciplinary approach in the management of pituitary apoplexy and to discuss modalities of presentation, treatment, and times of intervention.
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Affiliation(s)
- Adriana Albani
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Francesco Ferraù
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
- *Francesco Ferraù:
| | - Filippo Flavio Angileri
- Unit of Neurosurgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Felice Esposito
- Unit of Neurosurgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Francesca Granata
- Unit of Neuroradiology, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Felicia Ferreri
- Unit of Ophthalmology, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, Messina, Italy
| | - Salvatore Cannavò
- Unit of Endocrinology, Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
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