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Iglesias P. Pituitary Apoplexy: An Updated Review. J Clin Med 2024; 13:2508. [PMID: 38731037 PMCID: PMC11084238 DOI: 10.3390/jcm13092508] [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: 04/01/2024] [Revised: 04/21/2024] [Accepted: 04/23/2024] [Indexed: 05/13/2024] Open
Abstract
Pituitary apoplexy (PA) is an acute, life-threatening clinical syndrome caused by hemorrhage and/or infarction of the pituitary gland. It is clinically characterized by the sudden onset of headache. Depending on the severity, it may also be accompanied by nausea, vomiting, visual disturbances, varying degrees of adenohypophyseal hormone deficiency, and decreased level of consciousness. Corticotropic axis involvement may result in severe hypotension and contribute to impaired level of consciousness. Precipitating factors are present in up to 30% of cases. PA may occur at any age and sometimes develops during pregnancy or the immediate postpartum period. PA occurs more frequently in men aged 50-60, being rare in children and adolescents. It can develop in healthy pituitary glands or those affected by inflammation, infection, or tumor. The main cause of PA is usually spontaneous hemorrhage or infarction of a pituitary adenoma (pituitary neuroendocrine tumor, PitNET). It is a medical emergency requiring immediate attention and, in many cases, urgent surgical intervention and long-term follow-up. Although the majority of patients (70%) require surgery, about one-third can be treated conservatively, mainly by monitoring fluid and electrolyte levels and using intravenous glucocorticoids. There are scoring systems for PA with implications for management and therapeutic outcomes that can help guide therapeutic decisions. Management of PA requires proper evaluation and long-term follow-up by a multidisciplinary team with expertise in pituitary pathology. The aim of the review is to summarize and update the most relevant aspects of the epidemiology, etiopathogenesis, pathophysiology, clinical presentation and clinical forms, diagnosis, therapeutic strategies, and prognosis of PA.
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Affiliation(s)
- Pedro Iglesias
- Department of Endocrinology and Nutrition, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, 28222 Madrid, Spain
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Sun Y, Ren T, Ji X. Influence of hyperbaric oxygen therapy-specialized care on limb motor function and mental state of cerebral infarction patients with hemiplegia. Technol Health Care 2024; 32:1967-1976. [PMID: 38393863 DOI: 10.3233/thc-231643] [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] [Indexed: 02/25/2024]
Abstract
BACKGROUND Currently, cerebral infarction (CI) is mainly treated by emergency craniotomy or conservative treatment. However, some studies have questioned the functional recovery of patients after hyperbaric oxygen therapy (HBOT)-specialized care. OBJECTIVE This paper mainly explores the influence of HBOT-specialized care on limb motor function (LMF) and mental state of CI patients with hemiplegia. METHODS The medical records of 113 CI patients with hemiplegia treated in our hospital from March 2020 to March 2022 were collected. Of these, 53 received routine care nursing (conventional group) and 60 cases were given HBOT-specialized care (research group). Patient general data, scores of Fugl-Meyer Assessment (FMA), National Institutes of Health Stroke Scale (NIHSS), Self-rating Anxiety/Depression Scale (SAS/SDS) and Barthel Index (BI), and nursing efficiency were comparatively analyzed. RESULTS The two groups showed comparability in general data. FMA and BI scores were increased in the research group after rehabilitation treatment, higher than the baseline and those of the conventional group, while NIHSS, SAS, and SDS scores were reduced, lower compared with baseline and those of the conventional group. In addition, significantly higher nursing efficiency was determined in the research group. CONCLUSION HBOT-specialized care has beneficial effects on LMF, mental state, negative emotions and self-care ability of CI patients with hemiplegia and can enhance nursing efficacy, which deserves clinical popularization.
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Affiliation(s)
- Yi Sun
- Hyperbaric Oxygen Department, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China
- Hyperbaric Oxygen Department, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China
| | - Tao Ren
- Key Laboratory of Sports Rehabilitation and Training, Nanjing Sport Institute, Nanjing, Jiangsu, China
- Hyperbaric Oxygen Department, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China
| | - Xueli Ji
- Emergency Medical Center, The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, Jiangsu, China
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Zoli M, Guaraldi F, Rustici A, Cirillo L, Asioli S, Mazzatenta D. Bilateral antererior circulation stroke: A rare but threatening consequence of pituitary apoplexy. Case report and systematic literature review. Neuroradiol J 2023; 36:746-751. [PMID: 35343284 PMCID: PMC10649528 DOI: 10.1177/19714009221083146] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Brain stroke is a rare, life-threatening condition associated with pituitary apoplexy (PA), resulting from direct arterial occlusion due to mechanical compression secondary to the sudden enlargement of the pituitary adenoma, or to vessel vasospasm, induced by tumor hemorrhage. CASE REPORT We report the case of a 64-year-old woman with PA complicated by bilateral anterior circulation stroke due to critical stenosis of both anterior cerebral arteries (ACA). Despite the quick surgical decompression and consequent blood flow restoration, the neurological conditions of the patient did not improve and she died 18 days later. Ten other cases of anterior circulation stroke due to PA were retrieved in a systematic review of literature. Clinical and neuroradiological features of these patients and treatment outcome were assessed to suggest the most proper management. CONCLUSION The onset of neurological symptoms suggestive for brain stroke in patients with PA requires performing an emergency Magnetic Resonance Imaging (MRI), including Diffusion-weighted and angiographic MR-sequences. The role of surgery in these cases is debated, however, transsphenoidal adenomectomy would permit us to decompress the ACA and restore blood flow in their territories. Although the prognosis of PA-induced anterior circulation stroke is generally poor, a timely diagnosis and treatment would be paramount for improving patient outcome.
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Affiliation(s)
- Matteo Zoli
- Programma Neurochirurgia Ipofisi- Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Italy
| | - Federica Guaraldi
- Programma Neurochirurgia Ipofisi- Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy
| | - Arianna Rustici
- Department of Experimental, Diagnostic and Specialty Medicine (DIMES), University of Bologna, Italy
| | - Luigi Cirillo
- Programma Neurochirurgia Ipofisi- Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Italy
| | - Sofia Asioli
- Programma Neurochirurgia Ipofisi- Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Italy
| | - Diego Mazzatenta
- Programma Neurochirurgia Ipofisi- Pituitary Unit, IRCCS Istituto delle Scienze Neurologiche di Bologna, Italy
- Department of Biomedical and Neuromotor Sciences (DIBINEM), University of Bologna, Italy
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Brás-Cruz R, Cruz I, Camões S. Pituitary apoplexy and cerebral infarction. BMJ Case Rep 2023; 16:e254507. [PMID: 37185246 PMCID: PMC10151939 DOI: 10.1136/bcr-2022-254507] [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] [Indexed: 05/17/2023] Open
Abstract
Pituitary apoplexy (PA) is a possible complication of pituitary adenoma but is rarely followed by cerebral infarction. The mechanism by which this occurs is not totally understood but is believed to have multiple aetiologies such as arterial compression due to mass effect, vasospasm induced by the presence of blood or by vasoactive agents. In this report, we present a man in his 80s with known pituitary adenoma with a sudden onset of left central facial palsy, left hemiparesis, paresis of the VI left pair and previously unrecognised atrial fibrillation in the ECG. At first, the signs of haemorrhage on imaging were unnoticed, which led to a diagnosis of ischaemic stroke that was submitted to thrombolysis. Due to complications during hospitalisation, the team suspected of PA with panhypopituitarism, confirmed by brain MRI and blood tests. The patient underwent conservative management with glucocorticoids with resolution of the acute adrenal insufficiency related symptoms.
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Affiliation(s)
- Rute Brás-Cruz
- Department of Medicine - Internal Medicine, Hospital Pedro Hispano, Matosinhos, Portugal
| | - Isabel Cruz
- Internal Medicine, Centro Hospitalar de Vila Nova de Gaia Espinho EPE, Vila Nova de Gaia, Portugal
| | - Sara Camões
- Department of Medicine - Internal Medicine, Hospital Pedro Hispano, Matosinhos, Portugal
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Holanda TSF, Pimentel IMF, Araujo PVFG, da Silva Damasceno Gomes JÍ, de Morais Moreira VC, Soares TBS, de Albuquerque LAF. Unusual bifrontal cerebral infarction related to pituitary apoplexy. An uncommon presentation and literature review. Surg Neurol Int 2022; 13:577. [PMID: 36600731 PMCID: PMC9805633 DOI: 10.25259/sni_979_2022] [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: 10/25/2022] [Accepted: 11/29/2022] [Indexed: 12/14/2022] Open
Abstract
Background Pituitary apoplexy (PA) is a syndromic condition described in 1950. The main symptoms are headache, visual impairment, ophthalmoplegia, and hypopituitarism. The relationship between stroke and PA is uncommon and two mechanisms are described: vascular compression and vasospasm. Case Report A 65-old-year man presented with severe headache, vomiting, ophthalmoplegia, and somnolence. Radiological examinations showed an expansive sellar and suprasellar lesion with a heterogeneous signal, besides Diffusion-weighted imaging (DWI) restriction in the bifrontal area was present. The findings were compatible with PA and stroke. Conclusion PA leading to cerebral infarction is a rare condition that presents high morbidity and mortality levels. There are two main mechanisms related: direct arterial compression and arterial vasospasm. The cases must be conducted as neuroendocrinological emergencies and surgical management is a key point to better the prognosis of patients.
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Affiliation(s)
- Tiago S. F. Holanda
- Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, Brazil.,Corresponding author: Tiago S. F. Holanda, Department of Neurosurgery, General Hospital of Fortaleza, Fortaleza, Brazil.
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Wang LX, Li WH, He F. Efficacy and Safety of Electroacupuncture in the Treatment of Cerebral Infarction: Systematic Review and Meta-Analysis. Appl Bionics Biomech 2022; 2022:1350501. [PMID: 35800118 PMCID: PMC9256421 DOI: 10.1155/2022/1350501] [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: 05/01/2022] [Revised: 06/02/2022] [Accepted: 06/04/2022] [Indexed: 11/18/2022] Open
Abstract
Purpose The goal of this study was to see if electroacupuncture was effective and safe in the management of cerebral infarction. PubMed, Embase, Cochrane Library, and Web of Science were used to conduct a comprehensive literature survey. Methods Basic features of 7 studies were identified using the searching strategy. The investigation was found in PubMed, Embase, and Web of Science, with the most recent search being in March 2022. "Electroacupuncture," "cerebral infarction," and their permutations were among the MeSH terms and free words used. As literature, two reviewers independently used a standardized form to gather pertinent data from qualifying research. Results 157 literatures were identified and evaluated. Electroacupuncture improved the BI score in individuals with cerebral infarction (mean difference = 0.10, 95 percent CI: 0.00-0.20, p = 0.04). Electroacupuncture enhanced BI score in individuals with cerebral infarction (mean difference = 0.10, 95 percent CI: 0.00-0.20, p = 0.04). The effects of electroacupuncture increased Fugl-Meyer index in patients with cerebral infarction (mean difference = 25.92, 95% CI: 25.28-26.56, p < 0.00001). Electroacupuncture effects decreased CSS in patients with cerebral infarction in the experiment group (mean difference = -2.10, 95% CI: -2.53--1.67, p < 0.0001). Electroacupuncture also reduced CSS individuals with cerebral infarction in the control group; however, there was no statistically significant (risk difference = 0.06, 95 percent CI: 0.02-0.13, p = 0.12). Conclusion This study demonstrated that electroacupuncture helped decreased CSS in patients with cerebral infarction.
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Affiliation(s)
- Lan Xiang Wang
- Department of Rehabilitation Medicine, The 8th Medical Center of Chinese PLA General Hospital, China
| | - Wei Hong Li
- Beijing University of Chinese Medicine, China
| | - Fang He
- Department of Outpatient, The 8th Medical Center of Chinese PLA General Hospital, China
- Jia NO2 Niangniang Mansion, Xiangshan Road, Haidian District, Beijing 100093, China
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Classification Algorithm-Based fMRI Images for Evaluating the Effect of Yishen Tiaodu Acupuncture on the Recovery Period of Cerebral Infarction. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:3592145. [PMID: 35665277 PMCID: PMC9159848 DOI: 10.1155/2022/3592145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/30/2022] [Accepted: 04/27/2022] [Indexed: 11/18/2022]
Abstract
This study aimed to explore the application value of multifeature fusion classification algorithm based on deep learning and Yishen Tiaodu acupuncture in the diagnosis and treatment of patients with cerebral infarction in convalescence. Methods. 62 patients with cerebral infarction were randomly classified into the experimental group and the control group, with 31 patients in each group. All patients received the functional magnetic resonance imaging (fMRI) examination. The image processing method was the multifeature fusion classification algorithm based on deep learning. DICE coefficient, accuracy, and sensitivity were used to evaluate the image processing performance of traditional and new algorithms. Patients in the experimental group were treated with Yishen Tiaodu acupuncture, while patients in the control group were treated with ordinary acupuncture. The evaluation of the cyberchondria severity scale (CSS) and the activities of daily living (ADL) was performed at enrollment, 15 days after treatment, 28 days after treatment, and 1 month after treatment. The results showed that the quality of fMRI images processed by multifeature fusion classification algorithm based on deep learning was signally improved. The clinical efficacy of the traditional Chinese medicine (TCM) syndrome score (86.7% vs. 60.9%) and neurological impairment score (83.4% vs. 53.5%) in the experimental group were remarkably higher compared with the control group (P < 0.05). After treatment, the TCM syndrome score of the experimental group was markedly lower than that of the control group, while the ADL score was higher (P < 0.05). Conclusion. The performance of multifeature fusion classification algorithm based on deep learning in fMRI image processing of patients with cerebral infarction is better than that of traditional algorithms. Yishen Tiaodu acupuncture has a good therapeutic effect on the recovery of motor and neurological function in patients with cerebral infarction at convalescence.
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Van Dong H, Tran D, Chu HT, Pham AH, Nguyen XT, Duong HD. Emergency endoscopic surgery for pituitary apoplexy presenting as cerebral infarction in a limited resources condition: A case report. Int J Surg Case Rep 2021; 83:106015. [PMID: 34118525 PMCID: PMC8193137 DOI: 10.1016/j.ijscr.2021.106015] [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: 05/02/2021] [Revised: 05/17/2021] [Accepted: 05/21/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction and importance Pituitary apoplexy is defined as a sudden onset of neurologic deficit due to infarction or hemorrhage of the pituitary tumor. We report a case of emergency endoscopic surgery for pituitary apoplexy presenting as cerebral infarction due to ICA compression in a limited resources condition. Case presentation A 38-year-old female presented with acute onset of severe headache, decreased level of consciousness, decreased visual acuity bilaterally, aphasia, and right hemiparesis. Computed tomography angiography showed a hyperdense sellar mass with stenosis of the left ICA. The patient underwent emergent endoscopic transsphenoidal surgery for sellar decompression. Clinical discussion The epidermiology, presentation and diagnosis and strategy of treatments as well as their outcomes were discussed. Conclusion Pituitary apoplexy should be taken into consideration in a patient with increasing headache and neuro-ophthalmic symptoms. Pituitary apoplexy presenting as cerebral infarction is rare. The aim of surgery in emergency setting was sellar decompression. Endoscopic transsphenoidal surgery was an effective treatment. Pituitary apoplexy should be taken into consideration in a patient with increasing headache and neuro-ophthalmic symptoms. Pituitary apoplexy presenting as cerebral infarction is rare. The aim of surgery in emergency setting was sellar decompression. Endoscopic transsphenoidal surgery was an effective treatment.
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Affiliation(s)
- He Van Dong
- Department of Neurosurgery I, Viet Duc University Hospital, Hanoi, Viet Nam
| | - Dat Tran
- Department of Neurosurgery I, Viet Duc University Hospital, Hanoi, Viet Nam
| | - Hung Thanh Chu
- Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam.
| | - Anh Hoang Pham
- Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam; Department of Neurosurgery I, Viet Duc University Hospital, Hanoi, Viet Nam
| | - Xuan Thanh Nguyen
- Department of Neurosurgery I, Viet Duc University Hospital, Hanoi, Viet Nam
| | - Ha Dai Duong
- Department of Surgery, Hanoi Medical University, Hanoi, Viet Nam; Department of Neurosurgery I, Viet Duc University Hospital, Hanoi, Viet Nam.
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