1
|
Teramoto S, Tahara S, Kondo A, Morita A. Key Factors Related to Internal Carotid Artery Stenosis Associated with Pituitary Apoplexy. World Neurosurg 2021; 149:e447-e454. [PMID: 33567365 DOI: 10.1016/j.wneu.2021.02.005] [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: 01/15/2021] [Revised: 01/30/2021] [Accepted: 02/01/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Internal carotid artery (ICA) stenosis rarely occurs in pituitary apoplexy. Little is known of the causes of this condition. The present study investigated the factors related to ICA stenosis associated with pituitary apoplexy. METHODS Forty-five patients with pituitary apoplexy were retrospectively examined and divided into the stenotic and normal ICA groups. The baseline characteristics of patient background, tumor properties, clinical findings, and treatment overview were compared between the groups. RESULTS Eight patients were assigned to the stenotic ICA group and 37 to the normal ICA group. Patient age in the stenotic ICA group was significantly lower than that in the normal ICA group (P = 0.001). Maximum tumor diameter (P = 0.001), tumor volume (P = 0.044), and Knosp grade (P < 0.001) were significantly greater in the stenotic ICA group than in the normal ICA group. The stenotic ICA group had a significantly greater incidence of sphenoid sinus mucosal thickening than the normal-ICA group (P = 0.039). Multivariate logistic regression analysis demonstrated that age (odds ratio 0.915, 95% confidence interval 0.846-0.991, P = 0.029) was a significant and independent predictor of ICA stenosis associated with pituitary apoplexy. Receiver operating characteristic curve analysis showed that the optimal cut-off point for age was 35.0 years (specificity 0.946, sensitivity 0.750). CONCLUSIONS Our study revealed that age, tumor size, and sphenoid sinus mucosal thickening were strongly related to the occurrence of ICA stenosis in pituitary apoplexy. Among these factors, age had the potential of being an independent predictor of the condition.
Collapse
Affiliation(s)
- Shinichiro Teramoto
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan; Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan.
| | | | - Akihide Kondo
- Department of Neurosurgery, Juntendo University School of Medicine, Tokyo, Japan
| | - Akio Morita
- Department of Neurosurgery, Nippon Medical School, Tokyo, Japan
| |
Collapse
|
2
|
Elarjani T, Chen S, Cajigas I, Saway B, Sur S, Morcos JJ. Pituitary Apoplexy and Cerebral Infarction: Case Report and Literature Review. World Neurosurg 2020; 141:73-80. [DOI: 10.1016/j.wneu.2020.05.276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 10/24/2022]
|
3
|
Jiang Q, Xiao S, Shu L, Huang X, Chen X, Hong H. Pituitary Apoplexy Leading to Cerebral Infarction: A Systematic Review. Eur Neurol 2020; 83:121-130. [DOI: 10.1159/000507190] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 03/07/2020] [Indexed: 11/19/2022]
Abstract
Background: Cerebral infarction caused by pituitary apoplexy (PA) is rare. To characterize the clinical features of cerebral infarction caused by PA, we performed a systematic review. Summary: The clinical symptoms are mainly sudden headache, hemiplegia, visual impairment, disturbance of consciousness, and ophthalmalgia in patients with cerebral infarction caused by PA. Treatment for this type of infarction is different from treatment for general acute cerebral infarction. Compared to patients who underwent emergency surgery and conservative treatment, patients treated with delayed surgery showed a better prognosis and a lower mortality rate. Compared to patients who underwent craniotomy or conservative treatment, patients who underwent transsphenoidal surgery (TSS) not only improved well but also showed a lower mortality rate. Key Messages: PA rarely causes cerebral infarction, which is a critical condition with a poor prognosis and is more common in men. Delayed surgery and TSS appear to confer a better prognosis in patients with this condition.
Collapse
|
4
|
Chu C, Perilli GA, Judge C, Sheng S, Yacoub HA. Pituitary apoplexy mimicking meningoencephalitis: case report and scoping study. Hosp Pract (1995) 2020; 48:29-34. [PMID: 31976773 DOI: 10.1080/21548331.2020.1717801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: Pituitary apoplexy (PA) is a rare but potentially life-threatening condition that may require urgent surgical intervention.Case Presentation: We report a case of a patient who was initially diagnosed with meningoencephalitis (ME) based on clinical presentation and cerebrospinal fluid (CSF) analysis, but was eventually diagnosed with PA. We present a summary of other cases reported in the literature of PA mimicking ME and analyze their clinical features and CSF findings.Results: Among all 22 PA cases reviewed, headache was the most commonly reported symptom. Hypopituitarism was seen in 94.4% of the cases; of these, panhypopituitarism was noted in 38.9%. The sensitivity of magnetic resonance image (MRI) for detecting PA was 94.7%, much higher than that of computed tomography (CT), which was only 31.6%. Neutrophil predominant pleocytosis was present in all cases with a neutrophil percentage ranging from 73% to 98%. CSF leukocyte count was less than 1000/ul in 86% of the cases. CSF erythrocytosis was seen in 92.9% of the cases with a count ranging from 15 to 2030/ul. Elevated CSF protein was present in all cases with a range of 69.8 to 239 mg/dl. CSF glucose level varied with a range between 12 and 136 mg/dl; the level was greater than 40 mg/dl in 73% of the cases.Conclusion: PA tends to be misdiagnosed as ME due to the similarities of semiology and CSF findings. PA should be considered in refractory acute headache cases, especially those with visual and endocrine abnormalities. Early recognition and treatment may lead to significant reduction in morbidity and mortality.Abbreviations: ACTH: adrenocorticotropic hormone; CSF: cerebrospinal fluid; CT: computed tomography; GRE: gradient echo; HRT: hormone replacement therapy;HSV: Herpes Simplex Virus; IV: intravenous; ME: meningoencephalitis; MRI: magnetic resonance image; PA: pituitary apoplexy; RBC: red blood cell; WBC: white blood cell.
Collapse
Affiliation(s)
- Chun Chu
- Departments of Neurology, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Gretchen A Perilli
- Department of Endocrinology, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Casey Judge
- Departments of Neurology, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Sen Sheng
- Department of Neurology, University of Arkansas for Medical Sciences, Little, Rock, Arkansas
| | - Hussam A Yacoub
- Departments of Neurology, Lehigh Valley Health Network, Allentown, Pennsylvania
| |
Collapse
|
5
|
Wang J, Hu Z, Yang S, Liu C, Yang H, Wang D, Guo F. Inflammatory cytokines and cells are potential markers for patients with cerebral apoplexy in intensive care unit. Exp Ther Med 2018; 16:1014-1020. [PMID: 30116353 DOI: 10.3892/etm.2018.6213] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Accepted: 03/09/2018] [Indexed: 01/27/2023] Open
Abstract
Cerebral apoplexy is a disease caused by obstruction of the blood circulation in the brain. Evidence has indicated that inflammatory cytokines are implicated in ischaemic cerebral apoplexy and are regarded as a general cardiovascular risk factor, which may be a possible immediate trigger, a component of the response to tissue injury and a therapeutic target. The present study investigated changes of inflammatory cytokines and cells in patients with cerebral apoplexy at the intensive care unit (ICU). The plasma concentrations of inflammatory cytokines, including tumor necrosis factor (TNF)-α, interleukin (IL)-4, IL-6, IL-8, IL-10, IL-1β and IL-17A were evaluated using ELISA. Changes in the plasma concentrations of inflammatory cells were detected by using flow cytometry. The results indicated that serum levels of TNF-α, IL-4, IL-8, IL-1β and IL-17A were upregulated in patients with cerebral apoplexy compared with those in healthy individuals, while those of IL-6 and IL-10 were downregulated. Furthermore, it was demonstrated that the plasma concentration of lymphocytes, granulocytes and mononuclear cells was decreased in patients with cerebral apoplexy in the ICU compared with that in healthy individuals. Of note, humoral as well as cellular inflammatory cytokines were evidently increased in patients with cerebral apoplexy in ICU. In conclusion, the present study provided evidence that inflammatory cytokines and inflammatory cells are upregulated, while anti-inflammatory cytokines are downregulated in patients with cerebral apoplexy in an ICU setting. These results suggest that anti-inflammatory interventions may be beneficial either in the prevention or acute treatment of patients with cerebral apoplexy.
Collapse
Affiliation(s)
- Jianhong Wang
- Department of Neurology, The Affiliated Hospital of University of Electronic Science and Technology, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610054, P.R. China
| | - Zicheng Hu
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing 400042, P.R. China
| | - Shu Yang
- Department of Neurology, The Affiliated Hospital of University of Electronic Science and Technology, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610054, P.R. China
| | - Chengchun Liu
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing 400042, P.R. China
| | - Haimei Yang
- Department of Neurology, Daping Hospital, Third Military Medical University, Chongqing 400042, P.R. China
| | - Duozi Wang
- Department of Neurology, The Affiliated Hospital of University of Electronic Science and Technology, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610054, P.R. China
| | - Fuqiang Guo
- Department of Neurology, The Affiliated Hospital of University of Electronic Science and Technology, Sichuan Provincial People's Hospital, Chengdu, Sichuan 610054, P.R. China
| |
Collapse
|
6
|
Nagure PV, Nikam VR, Garud AS. Pituitary Apoplexy Producing Internal Carotid and Basilar Artery Compression: A Rare Case Report. Asian J Neurosurg 2018; 13:1264-1268. [PMID: 30459913 PMCID: PMC6208222 DOI: 10.4103/ajns.ajns_90_18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pituitary apoplexy is a rare disease followed by ischemic or hemorrhagic process within the pituitary adenoma. Here, we report two cases of pituitary apoplexy with a history of sudden onset of headache, vomiting, and diminished vision. Our aim is to share our experience and discuss these cases as follows: the first one to know the compression of basilar artery along with the compression of basilar part of pons and in both the cases with compression of an internal carotid artery leading to cerebral infarcts.
Collapse
Affiliation(s)
- Pramod Vaijnath Nagure
- Department of Radiodiagnosis, Prakash Institute of Medical Sciences, Islampur, West Bengal, India
| | - Vasudha Ravindra Nikam
- Department of Anatomy, D. Y. Patil Medical College, Dr. D.Y. Patil Education Society, Deemed to be University Kasaba Bawada, Kolhapur, Maharashtra, India
| | - Amit Sambhaji Garud
- Department of General Surgery, Islampur Multispeciality Hospital; Islampur, Sangli, Maharashtra, India
| |
Collapse
|
7
|
An Unusual Presentation of Pituitary Gland Apoplexy With Noninfectious Meningitis. Am J Forensic Med Pathol 2017; 39:23-26. [PMID: 29227295 DOI: 10.1097/paf.0000000000000370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pituitary adenomas make up 10% of intracranial tumors, but because of their location, they may go undetected for long periods. In this article, we report the case of a 68-year-old white man found deceased in his residence, who died of acute pituitary tumor apoplexy. He was known to have severe symptoms including acute headache, vision loss, and altered behavior. When found, his home was in extreme disarray, mimicking a possible assault. At autopsy, the decedent had multiple superficial abrasions about the upper and lower extremities, as well as a 2.5 × 3-cm pituitary adenoma compressing the carotid arteries and optic nerves. Initial coroner and police investigators were strongly considering homicide with robbery as a motive, given the disarray present at the scene. This case highlights the importance of postmortem examination of the pituitary gland in all cases where neurological symptoms are reported prior to death.
Collapse
|
8
|
Pasha SA, Ranganthan LN, Setty VK, Reddy R, Ponnuru DA. Acute Ischaemic Stroke as a Manifestation of Pituitary Apoplexy in a Young Lady. J Clin Diagn Res 2017; 11:OD03-OD05. [PMID: 28658829 PMCID: PMC5483731 DOI: 10.7860/jcdr/2017/25046.9782] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Accepted: 12/28/2016] [Indexed: 11/24/2022]
Abstract
Pituitary Apoplexy (PA) is defined as a clinical syndrome comprising headache, visual deficits and altered sensorium, which can result from haemorrhage or infarction of the pituitary gland. Acute ischaemic stroke following PA is very rare. We are presenting a 35-year-old young otherwise healthy lady who presented with neuro ophthalmological and vascular symptoms on a background of PA. Imaging revealed a pituitary macro adenoma with parasellar extension with internal bleed. Cerebral angiography revealed that the mass compressed the bilateral cavernous sinuses (left more than right), resulting in obliteration of the cavernous portion of the left Internal Carotid Artery (ICA). She was treated with steroids and surgical debulking of the tumour through trans-sphenoidal approach and postoperative imaging showed recanalization of the ICA with reduction of the tumour size. The histopathological diagnosis was consistent with pituitary macro adenoma. Patient improved in level of sensorium, eye movement and the patient showed almost full recovery after the operation. PA resulting in ICA occlusion is very rare. Early intervention is required for reducing mortality and morbidity and to improve quality of life.
Collapse
Affiliation(s)
- Shaik Afsar Pasha
- Associate Professor, Department of Neurology, NRI Medical College and General Hospital, Chinakakani, Guntur, Andhra Pradesh, India
| | | | - Vamsi Krishna Setty
- Assistant Professor, Department of Radiology, NRI Medical College and General Hospital, Chinakakani, Guntur, Andhra Pradesh, India
| | - Ramakrishna Reddy
- Professor, Department of Neurosurgery, NRI Medical College and General Hospital, Chinakakani, Guntur, Andhra Pradesh, India
| | - Deepika Ananda Ponnuru
- Postgraduate, Department of Medicine, NRI Medical College and General Hospital, Chinakakani, Guntur, Andhra Pradesh, India
| |
Collapse
|
9
|
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.
Collapse
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
| |
Collapse
|
10
|
Zou Z, Liu C, Sun B, Chen C, Xiong W, Che C, Huang H. Surgical treatment of pituitary apoplexy in association with hemispheric infarction. J Clin Neurosci 2015. [DOI: 10.1016/j.jocn.2015.03.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
11
|
Zhan R, Li X, Li X. Endoscopic Endonasal Transsphenoidal Approach for Apoplectic Pituitary Tumor: Surgical Outcomes and Complications in 45 Patients. J Neurol Surg B Skull Base 2015; 77:54-60. [PMID: 26949589 DOI: 10.1055/s-0035-1560046] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2015] [Accepted: 06/25/2015] [Indexed: 12/12/2022] Open
Abstract
Objective To assess the safety and effectiveness of the endoscopic endonasal transsphenoidal approach (EETA) for apoplectic pituitary adenoma. Design A retrospective study. Setting Qilu Hospital of Shandong University; Brain Science Research Institute, Shandong University. Participants Patients admitted to Qilu Hospital of Shandong University who were diagnosed with an apoplectic pituitary tumor and underwent EETA for resection of the tumor. Main Outcome Measures In total 45 patients were included in a retrospective chart review. Data regarding patient age, sex, presentation, lesion size, surgical procedure, extent of resection, clinical outcome, and surgical complications were obtained from the chart review. Results In total, 38 (92.7%) of 41 patients with loss of vision obtained visual remission postoperatively. In addition, 16 patients reported a secreting adenoma, and postsurgical hormonal levels were normal or decreased in 14 patients. All other symptoms, such as headache and alteration of mental status, recovered rapidly after surgery. Two patients (4.4%) incurred cerebrospinal fluid leakage. Six patients (13.3%) experienced transient diabetes insipidus (DI) postoperatively, but none of these patients developed permanent DI. Five patients (11.1%) developed hypopituitarism and were treated with replacement of hormonal medicine. No cases of meningitis, carotid artery injury, or death related to surgery were reported. Conclusion EETA offers a safe and effective surgical option for apoplectic pituitary tumors and is associated with low morbidity and mortality.
Collapse
Affiliation(s)
- Rucai Zhan
- Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Science Research Institute, Shandong University, Jinan, China; Department of Neurosurgery, Jinan Third People's Hospital, Jinan, Shandong, China
| | - Xueen Li
- Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Science Research Institute, Shandong University, Jinan, China
| | - Xingang Li
- Department of Neurosurgery, Qilu Hospital of Shandong University, Brain Science Research Institute, Shandong University, Jinan, China
| |
Collapse
|
12
|
Banerjee C, Snelling B, Hanft S, Komotar RJ. Bilateral cerebral infarction in the setting of pituitary apoplexy: a case presentation and literature review. Pituitary 2015; 18:352-8. [PMID: 24965694 DOI: 10.1007/s11102-014-0581-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Pituitary tumor apoplexy (PTA) is a potentially fatal condition caused by hemorrhage and rapid expansion of a pituitary tumor. One rare consequence of PTA is occlusion of the intracavernous carotid arteries, very rarely leading to cerebral infarction. PURPOSE To describe a case of PTA leading to bilateral cerebral infarction and provide an extensive literature review of all previously reported cases of PTA leading to cerebral infarction. We discuss how these cases contribute to our understanding of the management of PTA, and we also discuss the differences between cases associated with the reported mechanism of carotid occlusion (compression vs. vasospasm). CASE PRESENTATION A 56-year-old previously healthy woman complained of severe headache and visual loss one day after sustaining a fall from standing. Computed tomography demonstrated an enlarged sellar and suprasellar mass displacing both cavernous ICAs laterally, with multiple bilateral hypodense areas in the ICA distribution consistent with infarction. She clinically deteriorated and underwent endoscopic transsphenoidal gross total resection for suspected PTA within 48 hours after falling. Her prognosis remained poor after 5 days, and support was withdrawn. CONCLUSION Twenty-four cases of PTA leading to cerebral infarction have been previously documented-four bilateral, our case being the fifth. Based on our review, the presence of infarction itself does not seem to warrant surgical management in the absence of previously established indications for surgery (such as a deteriorating visual field), despite a 3-5 times mortality increase. No conclusion regarding the role of the mechanism of occlusion can be made at this time.
Collapse
Affiliation(s)
- Christopher Banerjee
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, USA,
| | | | | | | |
Collapse
|
13
|
A Case of Apoplexy of Rathke's Cleft Cyst Followed by Cerebral Infarction. Case Rep Neurol Med 2015; 2015:645370. [PMID: 25810933 PMCID: PMC4355814 DOI: 10.1155/2015/645370] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 02/14/2015] [Indexed: 11/17/2022] Open
Abstract
Rathke's cleft cyst (RCC) apoplexy is a rare clinical entity. We report a case of apoplexy of an RCC followed by cerebral infarction. A 67-year-old woman was found lying on the street unconscious. She had fallen from her motorbike. On referral to our hospital she gradually regained consciousness and presented with no neurological deficits. CT showed a round and slightly hyperdense area in the suprasellar region. However, the attending physician did not find this abnormal finding on CT and the patient was discharged the same day. Thirteen days after the first emergency visit she developed left hemiparesis and dysarthria. CT showed a round hypodense area in the suprasellar region. The change of the density in the suprasellar region on CT suggested the pituitary apoplexy. CT also showed a low density area in the territory of the right middle cerebral artery, which indicated the cerebral infarction. MR angiography revealed poor visibility and stenotic changes of right middle cerebral arteries. Transsphenoidal surgery was performed. Histopathological findings confirmed a hemorrhagic RCC. Postoperative MR angiography showed that the visibility and stenosis of right middle cerebral arteries were recovered. This is the rare case of apoplexy of an RCC followed by cerebral infarction.
Collapse
|
14
|
Chentli F, Akkache L, Daffeur K, Haddad M, Azzoug S. Suppurative meningitis: A life-threatening complication in male macroprolactinomas. Indian J Endocrinol Metab 2013; 17:S117-S121. [PMID: 24251128 PMCID: PMC3830274 DOI: 10.4103/2230-8210.119524] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Suppurative meningitis (SM) or bacterial meningitis is a life-threatening condition, which is exceptionally due to pituitary tumors (PT). Our aim was to analyze its frequency among male macroprolactinomas (MPRL) deemed to be aggressive, to report the cases we observed in our practice and describe the circumstances under which SM appeared. MATERIALS AND METHODS We retrospectively analyzed 82 male MPRL in order to look for a history of well proved SM and the circumstances under which SM appeared. We also took into account the possibility of SM relapsing. RESULTS Four out of 82 male MPRL had SM = 4.87%. Three consulted for SM symptoms. SM was confirmed in Infectious Diseases department, but only one had rhinorrhea. Hormonal assessment and cerebral magnetic resonance imaging pleaded for aggressive prolactinomas. After antibiotics, SM was sterilized. Then, MPRL were treated with bromocriptine, which normalized prolactin and reduced PT. SM never relapsed. The 4(th) case was hospitalized for a large multidirectional prolactinoma invading and/or arising from the skull base. He was operated on 3 times and then he was given Bromocriptine. After 3 months, he had rhinorrhea and then SM which was successfully treated by antibiotics. SM never relapsed after tumor reduction. CONCLUSION SM was demonstrated in 4.87%. SM has revealed MPRL in 3 cases and appeared after bromocriptine intake in the 4(th) one. Endocrinologists should be aware of this severe condition, which can be avoided by repairing as soon as possible the bony defect secondary to aggressive tumors, unless it is clogged by fibrosis: What probably happened in our cases.
Collapse
Affiliation(s)
- Farida Chentli
- Department of Endocrinology and Metabolic Diseases, Bab El Oued Hospital, 5Boulevard Said Touati, Algiers, Algeria
| | - Lina Akkache
- Department of Endocrinology and Metabolic Diseases, Bab El Oued Hospital, 5Boulevard Said Touati, Algiers, Algeria
| | - Katia Daffeur
- Department of Endocrinology and Metabolic Diseases, Bab El Oued Hospital, 5Boulevard Said Touati, Algiers, Algeria
| | - Meriem Haddad
- Department of Endocrinology and Metabolic Diseases, Bab El Oued Hospital, 5Boulevard Said Touati, Algiers, Algeria
| | - Said Azzoug
- Department of Endocrinology and Metabolic Diseases, Bab El Oued Hospital, 5Boulevard Said Touati, Algiers, Algeria
| |
Collapse
|
15
|
Rey-Dios R, Payner TD, Cohen-Gadol AA. Pituitary macroadenoma causing symptomatic internal carotid artery compression: surgical treatment through transsphenoidal tumor resection. J Clin Neurosci 2013; 21:541-6. [PMID: 24211140 DOI: 10.1016/j.jocn.2013.08.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Accepted: 08/07/2013] [Indexed: 11/29/2022]
Abstract
Pituitary macroadenomas can invade the cavernous sinus and rarely cause occlusion of the internal carotid artery (ICA). Most patients with symptomatic obstruction of the ICA by a pituitary tumor have been reported as a result of apoplexy. The authors review the literature about this condition and report a 48-year-old man who presented with transient ischemic attacks leading to a stroke. Imaging studies demonstrated complete occlusion of the left ICA and critical narrowing of the right ICA at the level of the clinoid processes, most likely due to macroadenoma mass effect. There was no radiologic evidence of apoplexy. Surgical resection of the tumor and ICA decompression via the transsphenoidal route resulted in prevention of further symptoms. Histopathologic analysis confirmed a nonfunctioning pituitary adenoma without evidence of hemorrhage or intratumoral infarction. This patient, to the authors' knowledge, is the first documented patient with symptomatic carotid compression by a pituitary adenoma without evidence of apoplexy.
Collapse
Affiliation(s)
- Roberto Rey-Dios
- Department of Neurosurgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Troy D Payner
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, 355 West 16th Street, Suite 5100, Indianapolis, IN 46202, USA
| | - Aaron A Cohen-Gadol
- Goodman Campbell Brain and Spine, Department of Neurological Surgery, Indiana University School of Medicine, 355 West 16th Street, Suite 5100, Indianapolis, IN 46202, USA.
| |
Collapse
|
16
|
Choudhry OJ, Choudhry AJ, Nunez EA, Eloy JA, Couldwell WT, Ciric IS, Liu JK. Pituitary tumor apoplexy in patients with Cushing's disease: endocrinologic and visual outcomes after transsphenoidal surgery. Pituitary 2012; 15:428-35. [PMID: 21927887 DOI: 10.1007/s11102-011-0342-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Pituitary apoplexy in patients with adrenocorticotropic hormone (ACTH) producing tumors is a rare occurrence. We report four patients with Cushing's disease harboring ACTH-secreting macroadenomas who presented with pituitary apoplexy. We report the endocrinologic and visual outcomes of these patients after emergent transsphenoidal surgery. A retrospective chart review was performed in 4 patients who presented with pituitary apoplexy from hemorrhage into an ACTH-secreting pituitary adenoma. The patient charts were reviewed for clinical presentation, neuroimaging findings, intraoperative surgical findings, pathologic findings, and postoperative endocrinologic and visual outcomes. All patients presented with acute headaches, nausea, vomiting, and visual loss from optic compression. MR imaging demonstrated a hemorrhagic macroadenoma that was confirmed at surgery. All patients underwent emergent transsphenoidal decompression (within 24 h of presentation). One of these underwent an additional craniotomy to resect residual tumor. Postoperatively, all patients showed significant improvement in visual acuity and visual fields with biochemical remission confirmed on laboratory testing. Significant weight loss as well as resolution of diabetes and hypertension was noted in all cases. All four patients remained in biochemical remission at their most recent follow-up visit (mean 40 months, range: 24-72 months). Excellent endocrine and visual outcomes can be achieved after emergent transsphenoidal surgery in patients with Cushing's disease presenting with pituitary apoplexy. Although the cure rates of non-apoplectic ACTH macroadenomas are generally poor, higher rates of remission can be achieved in cases of pituitary apoplexy. This may be partly due to the effects of tumor infarction.
Collapse
Affiliation(s)
- Osamah J Choudhry
- Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, 90 Bergen St, Suite 8100, Newark, NJ 07101, USA
| | | | | | | | | | | | | |
Collapse
|
17
|
Robert T, Sajadi A, Uské A, Levivier M, Bloch J. Fulminant Meningoencephalitis as the First Clinical Sign of an Invasive Pituitary Macroadenoma. Case Rep Neurol 2010; 2:133-138. [PMID: 21113283 PMCID: PMC2988847 DOI: 10.1159/000321844] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report the case of a young woman who presented with an acute fulminant meningoencephalitis as the first sign of an invasive pituitary macroadenoma. This rare and dramatic complication is described in detail, and the different management steps, from the lumbar puncture to the bifrontal craniectomy, are discussed. In conclusion, this clinical presentation highlights the importance of early diagnosis and urgent management of this uncommon complication.
Collapse
Affiliation(s)
- T Robert
- Department of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | | | | | | | | |
Collapse
|
18
|
Cerase A, Tarantino A, Muzii VF, Vittori C, Venturi C. Vasospasm and cerebral infarction from pituitary apoplexy. A case report. Neuroradiol J 2010; 23:321-4. [PMID: 24148592 DOI: 10.1177/197140091002300311] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2010] [Accepted: 04/27/2010] [Indexed: 11/17/2022] Open
Abstract
Pituitary apoplexy is a potentially life-threatening acute or subacute clinical syndrome occurring from enlargement of the pituitary gland, and pituitary insufficiency, from hemorrhage or ischemia from an unknown pituitary lesion, most frequently being a non-functioning macroadenoma. A close, and multidisciplinary management is required. The purpose of this case report is to increase awareness to pituitary apoplexy presentation and management by reporting clinical features and neuroradiological findings observed in a 70-year-old patient with an unknown pituitary lesion. He presented with pituitary apoplexy and brain ischemia at magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) maps. MR angiography (MRA) showed diffuse vasospasm of anterior and posterior circulation. Both MRI and cytochemical examination of the cerebrospinal fluid ruled out subarachnoid hemorrhage. Due to concomitant diseases, and absence of visual deficit, the management was conservative by medical and substitutive therapy, without surgery. Clinical follow-up showed clearcut improvement, and this was consistent with MRI and MRA evidence of vasospasm regression, and clearcut pituitary lesion shrinkage. Pituitary lesions with hemorrhagic infarction presenting with pituitary apoplexy may be associated with vasospasm and brain ischemia at diagnosis, also in the absence of subarachnoid hemorrhage. A correct MR evaluation of patients with PA should include DWI, ADC maps, and MRA. Notably, early diagnosis of PA-associated vasospasm and cerebral ischemia avoids the possibility of their detection only after neurosurgery.
Collapse
Affiliation(s)
- A Cerase
- Unit NINT Neuroimaging and Neurointervention, Department of Neurosciences, "Santa Maria alle Scotte" General Hospital; Siena, Italy -
| | | | | | | | | |
Collapse
|
19
|
Ben-Nakhi A, Muttikkal TJE, Chavan VNK, Al-Turkomani AY, Gupta R. Pituitary apoplexy: a rare cause of cerebral infarction. A case report. Neuroradiol J 2008; 21:661-5. [PMID: 24257008 DOI: 10.1177/197140090802100509] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 07/28/2008] [Indexed: 11/15/2022] Open
Abstract
Pituitary apoplexy is usually the result of hemorrhagic infarction in pituitary adenoma. The clinical presentation of pituitary apoplexy varies widely and includes asymptomatic hemorrhage, classical pituitary apoplexy and even sudden death. Few cases of cerebral infarction associated with pituitary apoplexy have been reported in the literature. Pituitary apoplexy can cause narrowing of intracranial vessels by mechanical obstruction due to mass effect or by vasospasm resulting in cerebral ischemia. We report a case of pituitary apoplexy associated with cerebral infarction and the putative mechanisms.
Collapse
Affiliation(s)
- A Ben-Nakhi
- Department of Radiology, Mubarak Al Kabeer Hospital; Farwaniya, Kuwait -
| | | | | | | | | |
Collapse
|