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Sugimoto R, Kenzaka T, Nishisaki H. Hyponatremia due to adrenal insufficiency after a Mamushi bite: a case report. BMC Endocr Disord 2023; 23:219. [PMID: 37821844 PMCID: PMC10566049 DOI: 10.1186/s12902-023-01466-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/20/2023] [Indexed: 10/13/2023] Open
Abstract
BACKGROUND Mamushi bites are the most common venomous snake bites in Japan, with known complications including rhabdomyolysis and acute kidney injury; however, adrenal insufficiency as a result of snake bites has not been previously reported. We report a case of empty sella with transient adrenal insufficiency during hospitalization for a Mamushi bite. CASE PRESENTATION An 84-year-old man was admitted to our hospital with a Mamushi bite on the right fifth finger. Serum sodium (Na) level remained in the normal range. On the ninth day of admission, he developed hyponatremia, with a serum Na level of 114 mEq/L and serum cortisol level of 4.0 μg/dL (reference value 4.5-21.1 μg/dL). His serum Na level was restored within the normal range after administration of corticosteroids with 3% NaCl solution. Both rapid adrenocorticotrophin and corticotropin-releasing hormone loading tests showed low cortisol response. Based on the results of the hormone loading tests, a diagnosis of pituitary adrenal insufficiency was made. Contrast-enhanced pituitary magnetic resonance imaging (MRI) showed primary empty sella. After discontinuation of corticosteroids, the hyponatremia did not recur, and the patient was discharged on the 24th day of hospitalization. After discharge, the patient visited an outpatient clinic, but hyponatremia recurrence was not observed. CONCLUSIONS This is the first report of hyponatremia due to pituitary adrenal insufficiency during hospitalization for a Mamushi bite in a patient with empty sella. When hyponatremia occurs during hospitalization for a Mamushi bite, cortisol measurement, hormone loading test, and head MRI should be performed to search for pituitary lesions because of the possibility of adrenal insufficiency caused by snake venom.
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Affiliation(s)
- Ryu Sugimoto
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7 Iso, Hikami-Cho, Tamba, 669-3495, Japan.
| | - Tsuneaki Kenzaka
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7 Iso, Hikami-Cho, Tamba, 669-3495, Japan
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Hogara Nishisaki
- Department of Internal Medicine, Hyogo Prefectural Tamba Medical Center, 2002-7 Iso, Hikami-Cho, Tamba, 669-3495, Japan
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Menon LP, Edem D. A case of giant prolactinoma and pituitary hemorrhage with the late recovery of pituitary function: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231190672. [PMID: 37533485 PMCID: PMC10392158 DOI: 10.1177/2050313x231190672] [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: 03/18/2023] [Accepted: 07/12/2023] [Indexed: 08/04/2023] Open
Abstract
Hypogonadotropic hypogonadism is a common finding in patients who are diagnosed with a prolactinoma. It can be accompanied by the presence of other pituitary hormone deficits, including secondary adrenal insufficiency and central hypothyroidism. While the proportion of improvement in endocrine deficits over the short term is well characterized, there is not enough literature about the recovery of pituitary function over the longer term. We present the case of a 23-year-old man with a giant prolactinoma who initially presented with pituitary hemorrhage and panhypopituitarism. He underwent decompression of the pituitary tumor followed by treatment with cabergoline. Over a 9-year follow-up period, we noted that the hypogonadotropic hypogonadism resolved after 4 years and the secondary adrenal insufficiency resolved after 8 years. This case suggests that partial or complete recovery of the pituitary function is possible over the long-term even in patients with a giant prolactinoma.
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Affiliation(s)
- Lakshmi P Menon
- Lakshmi P Menon, Division of Endocrinology and Metabolism, Department of Internal Medicine, University of Arkansas for Medical Sciences, 4301 W. Markham St., slot #587, Little Rock, AR 72205-7199, USA.
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3
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Funari A, Jeong SS, Pecorari IL, Flaquer I, Anderson CL, Agarwal V. Infarctive Apoplexy of Previously Healthy Pituitary Glands: A Small Case Series and Literature Review. J Neurol Surg Rep 2023; 84:e71-e79. [PMID: 37492614 PMCID: PMC10365896 DOI: 10.1055/s-0043-1770788] [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: 09/22/2022] [Accepted: 01/26/2023] [Indexed: 07/27/2023] Open
Abstract
Introduction We present two cases of suspected pituitary apoplexy found instead to be infarcted pituitary glands without histopathologic evidence of neoplastic cells, likely resulting from spontaneous infarction of previously healthy pituitary glands. Case Presentations The first case is a 55-year-old man who presented with a pulsating headache, nausea, and several months of decreased libido, polyuria, and polydipsia. Magnetic resonance imaging (MRI) revealed a rim-enhancing sellar/suprasellar mass with evidence of recent hemorrhage on the right. Testosterone, follicle-stimulating hormone, and luteinizing hormone levels were suppressed. Analysis of the resected specimen showed fibrocollagenous tissue with evidence of old hemorrhage and microscopic focus of necrotic tissue. The second case is a 56-year-old man who presented with a throbbing headache, associated nausea, and 6 weeks of polyuria and polydipsia. Testosterone levels were found to be low, and 8-hour water deprivation test showed evidence for partial diabetes insipidus. MRI revealed a mass on the right side of the pituitary gland, with evidence of likely hemorrhage on the left. Analysis of the resected specimen showed necrotic tissue without neoplastic cells. Conclusion When evaluating small pituitary lesions in patients presenting with indolent onset of pituitary insufficiency, there should be a high degree of suspicion for an infarcted pituitary gland.
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Affiliation(s)
- Abigail Funari
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Seth S. Jeong
- Department of Otolaryngology—Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Isabella L. Pecorari
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Isabella Flaquer
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Cassidy L. Anderson
- Department of Otolaryngology—Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
| | - Vijay Agarwal
- Department of Neurological Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
- Department of Otolaryngology—Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, New York, United States
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Zafar M, Mccallum V, Nash A, Kumar H, Waqar M, Mohammed Y, Skowronski C, Malik DA, Kiani A, Kumar S, Mucci E. An Unusual Case of Acute Confusion in an Elderly Man: Pituitary Apoplexy With Lateral Rectus Palsy. Cureus 2022; 14:e31064. [DOI: 10.7759/cureus.31064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2022] [Indexed: 11/07/2022] Open
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Comparative analysis of pituitary adenoma with and without apoplexy in pediatric and adolescent patients: a clinical series of 80 patients. Neurosurg Rev 2021; 45:491-498. [PMID: 33914243 DOI: 10.1007/s10143-021-01551-z] [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: 03/09/2021] [Revised: 04/01/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
Pituitary adenomas (PAs) have a low incidence in pediatric and adolescent patients, and their clinical characteristics remain unclear. As a severe complication of PA, apoplexy was investigated in young patients in the present study. Eighty patients younger than 20 years with PAs who underwent surgery were included and divided into an apoplexy group and non-apoplexy group. The clinical data of these two groups were statistically analyzed and compared. The study included 33 boys and 47 girls, with a mean age of 16.9 years. There were six (7.5%) adrenocorticotropic hormone-secreting, 13 (16.3%) growth hormone-secreting, 47 (58.7%) prolactin-secreting, and 14 (17.5%) non-functioning PAs. There were 34 (42.5%) patients in the apoplexy group and 46 (57.5%) patients in the non-apoplexy group. Pre-operatively, patients in the apoplexy group were more likely to have visual impairment (hazard ratio: 2.841, 95% confidence interval: 1.073-7.519; P = 0.033) and had poorer visual impairment scores than those in the non-apoplexy group (P = 0.027). Furthermore, a longer duration of symptoms before surgery was significantly correlated with a poorer visual outcome in the apoplexy group (R = - 1.204; P = 0.035). However, apoplexy was not associated with tumor type, tumor size, resection rate, or tumor recurrence. Tumor apoplexy is common in pediatric and adolescent patients with PAs and is associated with more severe preoperative visual deficits. Hence, the appropriate timing of surgical treatment may be important for rescuing visual function in young PA patients.
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Solorio-Pineda S, Almendárez-Sánchez CA, Tafur-Grandett AA, Ramos-Martínez GA, Huato-Reyes R, Ruiz-Flores MI, Sosa-Najera A. Pituitary macroadenoma apoplexy in a severe acute respiratory syndrome-coronavirus-2-positive testing: Causal or casual? Surg Neurol Int 2020; 11:304. [PMID: 33093981 PMCID: PMC7568102 DOI: 10.25259/sni_305_2020] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Accepted: 09/05/2020] [Indexed: 01/06/2023] Open
Abstract
Background: In December 2019, in Wuhan, a new virus emerged, causing severe acute respiratory syndrome (SARS) secondary to infection by a type of coronavirus, causing coronavirus disease (COVID-19). The pandemic caused by the new coronavirus has had implications in the central nervous system. COVID-19 is known to be characterized by coagulation activation and endothelial dysfunction, causing ischemic and hemorrhagic vascular syndromes. Case Description: A 27-year-old male patient case with progressive decrease in visual acuity, associated with respiratory symptoms and intense headache. Multilobar infiltrate with a reticulonodular pattern is evident on chest CT scan. Brain CT scan with pituitary macroadenoma apoplexy was shown. SARS-Cov2 was confirmed, and respiratory support initiated. However, the patient died shortly afterward, secondary to pulmonary complications. Conclusion: The angiotensin-converting enzyme (ACE) II receptor is expressed in circumventricular organs and in cerebrovascular endothelial cells, which play a role in vascular autoregulation and cerebral blood flow. For this reason, is rational the hypothesize that brain ACE II could be involved in COVID-19 infection. Underlying mechanisms require further elucidation in the future.
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Affiliation(s)
- Saúl Solorio-Pineda
- Department of Neurosurgery, Centro Medico "Lic. Adolfo López Mateos", Instituto de Salud del Estado de México, Av. Nicolás San Juan s/n Ex Hacienda La Magdalena, Toluca - 50010, Estado de México, México
| | - César Adán Almendárez-Sánchez
- Department of Neurosurgery, Centro Medico "Lic. Adolfo López Mateos", Instituto de Salud del Estado de México, Av. Nicolás San Juan s/n Ex Hacienda La Magdalena, Toluca - 50010, Estado de México, México
| | - Abrahan Alfonso Tafur-Grandett
- Department of Neurosurgery, Centro Medico "Lic. Adolfo López Mateos", Instituto de Salud del Estado de México, Av. Nicolás San Juan s/n Ex Hacienda La Magdalena, Toluca - 50010, Estado de México, México
| | - Gabriel Arturo Ramos-Martínez
- Department of Neurosurgery, Centro Medico "Lic. Adolfo López Mateos", Instituto de Salud del Estado de México, Av. Nicolás San Juan s/n Ex Hacienda La Magdalena, Toluca - 50010, Estado de México, México
| | - Raúl Huato-Reyes
- Department of Neurosurgery, Centro Medico "Lic. Adolfo López Mateos", Instituto de Salud del Estado de México, Av. Nicolás San Juan s/n Ex Hacienda La Magdalena, Toluca - 50010, Estado de México, México
| | - Milton Inocencio Ruiz-Flores
- Department of Neurosurgery, Centro Medico "Lic. Adolfo López Mateos", Instituto de Salud del Estado de México, Av. Nicolás San Juan s/n Ex Hacienda La Magdalena, Toluca - 50010, Estado de México, México
| | - Antonio Sosa-Najera
- Department of Neurosurgery, Centro Medico "Lic. Adolfo López Mateos", Instituto de Salud del Estado de México, Av. Nicolás San Juan s/n Ex Hacienda La Magdalena, Toluca - 50010, Estado de México, México
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7
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Brown TV, Cheesman KC, Post KD. RECURRENT PITUITARY APOPLEXY IN AN ADENOMA WITH SWITCHING PHENOTYPES. AACE Clin Case Rep 2020; 6:e221-e224. [PMID: 32984525 DOI: 10.4158/accr-2019-0273] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 04/17/2020] [Indexed: 11/15/2022] Open
Abstract
Objective To describe an unusual presentation of a patient with recurrent pituitary apoplexy of an adenoma that switched phenotypes from a nonfunctioning, or silent gonadotroph adenoma (SGA), to a silent corticotroph adenoma (SCA). We discuss the potential etiologies of both recurrent pituitary apoplexy and phenotype switching of pituitary tumors. Methods The presented case includes clinical and biochemical findings, surgical outcomes, and pathologic reports related to the treatment of our patient who presented with recurrent pituitary apoplexy. Results A 56-year-old man presented for evaluation of decreased libido and was found to have a low testosterone level. A pituitary magnetic resonance image demonstrated an 8-mm pituitary adenoma. He underwent transsphenoidal surgery (TSS) to remove the tumor and pathology demonstrated an SGA immunopositive for luteinizing hormone and follicle-stimulating hormone with evidence of apoplexy. Eight years later, the patient underwent another TSS after developing acute-onset headache, vomiting, and a cranial nerve palsy. Pathology at this time showed a necrotic tumor consistent with apoplexy with negative immunostains for all pituitary tumors. Three years after this, the tumor recurred and after another TSS the tumor stained positive for adrenocorticotropic hormone but was negative for luteinizing hormone and follicle-stimulating hormone with hemorrhage consistent with apoplexy. A few years afterward, he again developed acute-onset headache and cranial nerve palsies and had another TSS. On pathology, the tumor demonstrated extensive necrosis consistent with apoplexy and again stained positive for adrenocorticotropic hormone. The patient was then referred for radiation therapy and was subsequently lost to follow up. Conclusion Recurrent pituitary apoplexy in the same patient has only been described 3 times in the literature. There have been no case reports of a pituitary adenoma that switched phenotypes from an SGA to SCA. We suggest that pituitary apoplexy may recur multiple times due to a tumor with particularly fragile vessel walls and increased vascularization. We review the literature that suggests clinical and molecular similarities between SGAs and SCAs. Further studies are needed to determine the etiologies of recurrent apoplexy and pituitary adenomas with switching phenotypes.
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Affiliation(s)
- Teresa V Brown
- Division of Endocrinology, Diabetes, and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Khadeen C Cheesman
- Division of Endocrinology, Diabetes, and Bone Disease, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kalmon D Post
- Department of Neurosurgery, Mount Sinai Hospital, New York, New York
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8
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Patel A, Mobley BC, Jagasia M, Adetola K, Byrne M, Dholaria B. Pituitary Apoplexy During Hematopoietic Cell Transplantation. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e691-e693. [PMID: 32620383 DOI: 10.1016/j.clml.2020.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 11/25/2022]
Affiliation(s)
- Aneri Patel
- M.P. Shah Government Medical College, Jamnagar, Gujarat, India
| | - Bret C Mobley
- Department of Pathology, Vanderbilt University Medical Center, Nashville, TN
| | - Madan Jagasia
- Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Kassim Adetola
- Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN
| | - Michael Byrne
- Department of Hematology-Oncology, Vanderbilt University Medical Center, Nashville, TN
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9
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Vision Outcomes in Early versus Late Surgical Intervention of Pituitary Apoplexy: Meta-Analysis. World Neurosurg 2019; 127:52-57. [DOI: 10.1016/j.wneu.2019.03.133] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/13/2019] [Accepted: 03/14/2019] [Indexed: 12/26/2022]
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10
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Dahi S, Laaribi N, Alsubari A, Aachak M, Errahali Y, El Asri F, Reda K, Oubaaz A. [Unilateral visual loss revealing nercotic prolactinoma]. J Fr Ophtalmol 2019; 42:e79-e82. [PMID: 30679124 DOI: 10.1016/j.jfo.2018.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 05/09/2018] [Indexed: 11/28/2022]
Affiliation(s)
- S Dahi
- Service d'ophtalmologie, Hôpital militaire d'instruction Mohammed V, Faculté de médecine et de pharmacie, université Mohammed V-Rabat-Maroc, Rabat Maroc
| | - N Laaribi
- Service d'ophtalmologie, Hôpital militaire d'instruction Mohammed V, Faculté de médecine et de pharmacie, université Mohammed V-Rabat-Maroc, Rabat Maroc.
| | - A Alsubari
- Service d'ophtalmologie, Hôpital militaire d'instruction Mohammed V, Faculté de médecine et de pharmacie, université Mohammed V-Rabat-Maroc, Rabat Maroc
| | - M Aachak
- Service d'ophtalmologie, Hôpital militaire d'instruction Mohammed V, Faculté de médecine et de pharmacie, université Mohammed V-Rabat-Maroc, Rabat Maroc
| | - Y Errahali
- Service d'endocrinologie, Hôpital militaire d'instruction Mohammed V, Faculté de médecine et de pharmacie, université Mohammed V-Rabat-Maroc, Rabat Maroc
| | - F El Asri
- Service d'ophtalmologie, Hôpital militaire d'instruction Mohammed V, Faculté de médecine et de pharmacie, université Mohammed V-Rabat-Maroc, Rabat Maroc
| | - K Reda
- Service d'ophtalmologie, Hôpital militaire d'instruction Mohammed V, Faculté de médecine et de pharmacie, université Mohammed V-Rabat-Maroc, Rabat Maroc
| | - A Oubaaz
- Service d'ophtalmologie, Hôpital militaire d'instruction Mohammed V, Faculté de médecine et de pharmacie, université Mohammed V-Rabat-Maroc, Rabat Maroc
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11
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Abstract
RATIONALE Pituitary apoplexy (PA) is a syndrome caused by acute hemorrhage or infarction of the pituitary gland, generally within a pituitary adenoma. PA following spinal surgery is a very rare complication and may be difficult to diagnose. However, early diagnosis of PA is essential for the timely treatment of pan-hypopituitarism and prevention of severe neurologic complications. PATIENT CONCERNS A 73-year-old man had a posterior lumbar fusion surgery over a period of 8 hours on prone position. The patient complained of severe intractable headache accompanied by ophthalmalgia and ptosis on right eye 2 days after the surgery. DIAGNOSIS Brain magnetic resonance imaging revealed a 1.3 × 2.6 × 2 cm mass in the sellar fossa and suprasellar region and the laboratory tests indicated pan-hypopituitarism. INTERVENTIONS High-dose intravenous steroid therapy and trans-sphenoidal hypophysectomy were performed. OUTCOMES Pathological evaluation of the surgical specimen revealed a pituitary adenoma with total necrosis, indicating that the PA occurred because of tumor infarction. The patient recovered fully after resection of the pituitary adenoma and hormonal therapy. LESSONS Even though the incidence is low, PA has been related to blood pressure fluctuations or vasospasm during surgery. PA should be considered during differential diagnosis in cases of postoperative severe headache or ophthalmic complications.
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12
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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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13
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Wang AR, Gill JR. The Pituitary Gland: An Infrequent but Multifaceted Contributor to Death. Acad Forensic Pathol 2016; 6:206-216. [PMID: 31239893 DOI: 10.23907/2016.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 03/31/2016] [Accepted: 04/27/2016] [Indexed: 11/12/2022]
Abstract
The pituitary gland has an important role in homeostasis and disorders of it can result in endocrine dysfunction and/or produce mass effect on surrounding structures, including the hypothalamus, which can cause significant morbidity and mortality. A definitive clinical diagnosis may be delayed or remain elusive and lead to life-threatening conditions. Specifically, pituitary adenomas, pituitary necrosis, hypophysitis, and abscesses have all been reported in the literature to cause sudden and unexpected death and may only be first encountered at autopsy. Recognition by the forensic pathologist of these rare entities is crucial for appropriate death certification. This review emphasizes the need for a comprehensive, detailed forensic examination, including autopsy and routine histologic sampling of the pituitary gland, in order to ascertain its potential role in sudden unexpected death with no other apparent cause.
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Affiliation(s)
- Amber R Wang
- Hospital of the University of Pennsylvania - Division of Neuropathology, Department of Pathology
| | - James R Gill
- Hospital of the University of Pennsylvania - Division of Neuropathology, Department of Pathology
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14
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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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15
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Glezer A, Bronstein MD. Pituitary apoplexy: pathophysiology, diagnosis and management. ARCHIVES OF ENDOCRINOLOGY AND METABOLISM 2016; 59:259-64. [PMID: 26154095 DOI: 10.1590/2359-3997000000047] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 05/29/2015] [Indexed: 11/21/2022]
Abstract
Pituitary apoplexy is characterized by sudden increase in pituitary gland volume secondary to ischemia and/or necrosis, usually in a pituitary adenoma. Most cases occur during the 5th decade of life, predominantly in males and in previously unknown clinically non-functioning pituitary adenomas. There are some predisposing factors as arterial hypertension, anticoagulant therapy and major surgery. Clinical picture comprises headache, visual impairment, cranial nerve palsies and hypopituitarism. Most cases improve with both surgical and expectant management and the best approach in the acute phase is still controversial. Surgery, usually by transsphenoidal route, is indicated if consciousness and/or vision are impaired, despite glucocorticoid replacement and electrolyte support. Pituitary function is impaired in most patients before apoplexy and ACTH deficiency is common, which makes glucocorticoid replacement needed in most cases. Pituitary deficiencies, once established, usually do not recover, regardless the treatment. Sellar imaging and endocrinological function must be periodic reevaluated.
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Affiliation(s)
- Andrea Glezer
- Hospital das Clinicas, Medical School, University of Sao Paulo, São Paulo, SP, Brazil
| | - Marcello D Bronstein
- Hospital das Clinicas, Medical School, University of Sao Paulo, São Paulo, SP, Brazil
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16
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Diri H, Karaca Z, Tanriverdi F, Unluhizarci K, Kelestimur F. Sheehan's syndrome: new insights into an old disease. Endocrine 2016; 51:22-31. [PMID: 26323346 DOI: 10.1007/s12020-015-0726-3] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Accepted: 08/20/2015] [Indexed: 10/23/2022]
Abstract
Sheehan's syndrome (SS) is a parturition-related pituitary disease resulting from severe postpartum hemorrhage and can present with varying degrees of pituitary insufficiency. Pathological and clinical findings of SS were first described by Harold L. Sheehan in the previous century. Although his definitions are still valid, various studies and reports including new data have subsequently been published. Additionally, the diagnosis of SS has often been overlooked and thus delayed for long years due to its nonspecific signs and symptoms. Therefore, a large number of patients may be remained undiagnosed and untreated. SS is not as rare as assumed in developed countries, probably due to migrant women and unawareness of physicians regarding the syndrome. In this review, we provide a detailed review of the epidemiology, etiopathogenesis, clinical, laboratory and radiological features, new diagnostic criteria, differential diagnosis, and treatment of SS.
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Affiliation(s)
- Halit Diri
- Department of Endocrinology, Erciyes University Medical School, 38039, Kayseri, Turkey
| | - Zuleyha Karaca
- Department of Endocrinology, Erciyes University Medical School, 38039, Kayseri, Turkey
| | - Fatih Tanriverdi
- Department of Endocrinology, Erciyes University Medical School, 38039, Kayseri, Turkey
| | - Kursad Unluhizarci
- Department of Endocrinology, Erciyes University Medical School, 38039, Kayseri, Turkey
| | - Fahrettin Kelestimur
- Department of Endocrinology, Erciyes University Medical School, 38039, Kayseri, Turkey.
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17
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Abstract
Pituitary apoplexy, a rare clinical syndrome secondary to abrupt hemorrhage or infarction, complicates 2%-12% of pituitary adenomas, especially nonfunctioning tumors. Headache of sudden and severe onset is the main symptom, sometimes associated with visual disturbances or ocular palsy. Signs of meningeal irritation or altered consciousness may complicate the diagnosis. Precipitating factors (increase in intracranial pressure, arterial hypertension, major surgery, anticoagulant therapy or dynamic testing, etc) may be identified. Corticotropic deficiency with adrenal insufficiency may be life threatening if left untreated. Computed tomography or magnetic resonance imaging confirms the diagnosis by revealing a pituitary tumor with hemorrhagic and/or necrotic components. Formerly considered a neurosurgical emergency, pituitary apoplexy always used to be treated surgically. Nowadays, conservative management is increasingly used in selected patients (those without important visual acuity or field defects and with normal consciousness), because successive publications give converging evidence that a wait-and-see approach may also provide excellent outcomes in terms of oculomotor palsy, pituitary function and subsequent tumor growth. However, it must be kept in mind that studies comparing surgical approach and conservative management were retrospective and not controlled.
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Affiliation(s)
- Claire Briet
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Endocriniennes Rares de la Croissance (C.B., S.S., P.C.), Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre F94275, France; Service d'Endocrinologie (C.B.), Centre Hospitalier Universitaire d'Angers, Angers 49000, France; Service d'Endocrinologie (J.-F.B.), Centre Hospitalier Universitaire de Liège, Liège B4000, Belgium; Unité Mixte de Recherche S1185 (P.C.), Université Paris-Saclay, Université Paris-Sud; and Institut National de la Santé et de la Recherche Médicale Unité 1185, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre F94276, France; and Neurosurgery, Harvard Medical School, Brigham and Women's Hospital (E.R.L.), Boston, Massachusetts 02115
| | - Sylvie Salenave
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Endocriniennes Rares de la Croissance (C.B., S.S., P.C.), Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre F94275, France; Service d'Endocrinologie (C.B.), Centre Hospitalier Universitaire d'Angers, Angers 49000, France; Service d'Endocrinologie (J.-F.B.), Centre Hospitalier Universitaire de Liège, Liège B4000, Belgium; Unité Mixte de Recherche S1185 (P.C.), Université Paris-Saclay, Université Paris-Sud; and Institut National de la Santé et de la Recherche Médicale Unité 1185, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre F94276, France; and Neurosurgery, Harvard Medical School, Brigham and Women's Hospital (E.R.L.), Boston, Massachusetts 02115
| | - Jean-François Bonneville
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Endocriniennes Rares de la Croissance (C.B., S.S., P.C.), Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre F94275, France; Service d'Endocrinologie (C.B.), Centre Hospitalier Universitaire d'Angers, Angers 49000, France; Service d'Endocrinologie (J.-F.B.), Centre Hospitalier Universitaire de Liège, Liège B4000, Belgium; Unité Mixte de Recherche S1185 (P.C.), Université Paris-Saclay, Université Paris-Sud; and Institut National de la Santé et de la Recherche Médicale Unité 1185, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre F94276, France; and Neurosurgery, Harvard Medical School, Brigham and Women's Hospital (E.R.L.), Boston, Massachusetts 02115
| | - Edward R Laws
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Endocriniennes Rares de la Croissance (C.B., S.S., P.C.), Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre F94275, France; Service d'Endocrinologie (C.B.), Centre Hospitalier Universitaire d'Angers, Angers 49000, France; Service d'Endocrinologie (J.-F.B.), Centre Hospitalier Universitaire de Liège, Liège B4000, Belgium; Unité Mixte de Recherche S1185 (P.C.), Université Paris-Saclay, Université Paris-Sud; and Institut National de la Santé et de la Recherche Médicale Unité 1185, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre F94276, France; and Neurosurgery, Harvard Medical School, Brigham and Women's Hospital (E.R.L.), Boston, Massachusetts 02115
| | - Philippe Chanson
- Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Endocriniennes Rares de la Croissance (C.B., S.S., P.C.), Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre F94275, France; Service d'Endocrinologie (C.B.), Centre Hospitalier Universitaire d'Angers, Angers 49000, France; Service d'Endocrinologie (J.-F.B.), Centre Hospitalier Universitaire de Liège, Liège B4000, Belgium; Unité Mixte de Recherche S1185 (P.C.), Université Paris-Saclay, Université Paris-Sud; and Institut National de la Santé et de la Recherche Médicale Unité 1185, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre F94276, France; and Neurosurgery, Harvard Medical School, Brigham and Women's Hospital (E.R.L.), Boston, Massachusetts 02115
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Johnston PC, Hamrahian AH, Weil RJ, Kennedy L. Pituitary tumor apoplexy. J Clin Neurosci 2015; 22:939-44. [PMID: 25800143 DOI: 10.1016/j.jocn.2014.11.023] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2014] [Revised: 11/23/2014] [Accepted: 11/25/2014] [Indexed: 11/20/2022]
Abstract
We review the etiology, investigations, management and outcomes of pituitary tumor apoplexy. Pituitary tumor apoplexy is a clinical syndrome which typically includes the acute onset of headache and/or visual disturbance, cranial nerve palsy and partial or complete endocrine dysfunction. It is associated with either infarction or hemorrhage of a pre-existing pituitary adenoma and is associated with significant morbidity and potential fatality. Not all patients will present with classic signs and symptoms, therefore it is pertinent to appreciate the clinical spectrum in which this condition can present.
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Affiliation(s)
- Philip C Johnston
- Regional Center for Endocrinology and Diabetes, Royal Victoria Hospital, Grosvenor Road, Belfast, Northern Ireland BT12 6BA, UK; Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Amir H Hamrahian
- Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Robert J Weil
- Department of Neurosurgery, Geisinger Health System, Danville, PA, USA
| | - Laurence Kennedy
- Department of Endocrinology, Diabetes and Metabolism, Cleveland Clinic Foundation, Cleveland, OH, USA
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Kuhadiya ND, Desai A, Makdissi A, Batra M, Chaudhuri A. Cocaine-Induced Pituitary Apoplexy and Panhypopituitarism. AACE Clin Case Rep 2015. [DOI: 10.4158/ep14306.cr] [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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Sasaki S, Fujisawa I, Ishihara T, Tahara Y, Kazuma M, Fujiwara Y, Iwakura T, Hino M, Matsuoka N. A novel hook-shaped enhancement on contrast-enhanced sagittal magnetic resonance image in acute Sheehan's syndrome: a case report. Endocr J 2014; 61:71-6. [PMID: 24162077 DOI: 10.1507/endocrj.ej13-0280] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We report characteristic magnetic resonance (MR) image findings in a case of Sheehan's syndrome. A 37-year-old woman experienced complications of retained placenta and massive bleeding (3600 g) during delivery of a full-term baby. A pituitary function test demonstrated panhypopituitarism. MR image of the pituitary gland on postpartum day 10 revealed swelling of the anterior lobe. A hook-shaped enhancement was demonstrated on a sagittal image. The pituitary stalk, majority of the marginal zone of the anterior lobe, the anterior lobe just in front of the posterior lobe, and posterior lobe were well enhanced. In contrast, the central portion and the superior margin, just in front of the stalk insertion of the anterior lobe, were not enhanced. Anatomically, blood supply to these unenhanced portions of the anterior lobe was via the hypophyseal long portal vein and trabecular artery, which are tributaries of the superior hypophyseal artery that originate far from the internal carotid artery. Based on clinical history and MR image findings, the patient was diagnosed with Sheehan's syndrome and treated with hydrocortisone and levothyroxine. Follow-up MR image revealed marked atrophy of the anterior lobe. The characteristic hook-shaped enhancement in Sheehan's syndrome well reflected the vulnerability to massive bleeding based on the complex pituitary vasculature, which has not been reported previously. MR image with contrast enhancement is useful in the diagnosis of the acute phase of Sheehan's syndrome and in evaluating infarction of the anterior lobe.
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Affiliation(s)
- Sho Sasaki
- Department of Endocrinology and Diabetes, Kobe City Medical Center General Hospital, Kobe 650-0047, Japan
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Pituitary apoplexy associated with cabergoline therapy. J Clin Neurosci 2013; 20:1637-43. [DOI: 10.1016/j.jocn.2013.02.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 02/10/2013] [Indexed: 11/22/2022]
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Fleck SK, Wallaschofski H, Rosenstengel C, Matthes M, Kohlmann T, Nauck M, Schroeder HWS, Spielhagen C. Prevalence of hypopituitarism after intracranial operations not directly associated with the pituitary gland. BMC Endocr Disord 2013; 13:51. [PMID: 24188166 PMCID: PMC4175102 DOI: 10.1186/1472-6823-13-51] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2013] [Accepted: 10/24/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over the last few years, awareness and detection rates of hypopituitarism following traumatic brain injury (TBI) and subarachnoid hemorrhage (SAH) has steadily increased. Moreover, recent studies have found that a clinically relevant number of patients develop pituitary insufficiency after intracranial operations and radiation treatment for non-pituitary tumors. But, in a substantial portion of more than 40%, the hypopituitarism already exists before surgery. We sought to determine the frequency, pattern, and severity of endocrine disturbances using basal and advanced dynamic pituitary testing following non-pituitary intracranial procedures. METHODS 51 patients (29 women, 22 men) with a mean age of 55 years (range of 20 to 75 years) underwent prospective evaluation of basal parameters and pituitary function testing (combined growth hormone releasing hormone (GHRH)/arginine test, insulin tolerance test (ITT), low dose adrenocorticotropic hormone (ACTH) test), performed 5 to 168 months (median 47.2 months) after intracranial operation (4 patients had additional radiation and 2 patients received additional radiation combined with chemotherapy). RESULTS We discovered an overall rate of hypopituitarism with distinct magnitude in 64.7% (solitary in 45.1%, multiple in 19.6%, complete in 0%). Adrenocorticotropic hormone insufficiency was found in 51.0% (partial in 41.2%, complete in 9.8%) and growth hormone deficiency (GHD) occurred in 31.4% (partial in 25.5%, severe in 5.9%). Thyrotropic hormone deficiency was not identified. The frequency of hypogonadism was 9.1% in men. Pituitary deficits were associated with operations both in close proximity to the sella turcica and more distant regions (p = 0.91). Age (p = 0.76) and gender (p = 0.24) did not significantly differ across patients with versus those without hormonal deficiencies. Groups did not significantly differ across pathology and operation type (p = 0.07). CONCLUSION Hypopituitarism occurs more frequently than expected in patients who have undergone neurosurgical intracranial procedures for conditions other then pituitary tumors or may already exists in a neurosurgical population before surgery. Pituitary function testing and adequate substitution may be warranted for neurosurgical patients with intracranial pathologies at least if unexplained symptoms like fatigue, weakness, altered mental activity, and decreased exercise tolerance are present.
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Affiliation(s)
- Steffen Kristian Fleck
- Department of Neurosurgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
| | - Henri Wallaschofski
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
| | - Christian Rosenstengel
- Department of Neurosurgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
| | - Marc Matthes
- Department of Neurosurgery, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
| | - Thomas Kohlmann
- Institute of Community Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
| | | | - Christin Spielhagen
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Strasse, 17475 Greifswald, Germany
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Fraser CL, Biousse V, Newman NJ. Visual outcomes after treatment of pituitary adenomas. Neurosurg Clin N Am 2012; 23:607-19. [PMID: 23040747 DOI: 10.1016/j.nec.2012.06.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Pituitary adenomas frequently manifest with neuro-ophthalmic symptoms and signs. The location of the pituitary gland makes involvement of both the visual pathways and the ocular motor cranial nerves likely when there is adenomatous expansion. A sudden expression of visual loss or diplopia commonly accompanies pituitary apoplexy. Several preoperative neuro-ophthalmic indicators help predict posttreatment outcomes and help determine the best intervention. Treatments themselves may also cause neuro-ophthalmic complications. The current literature and avenues of future research are reviewed.
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Affiliation(s)
- Clare Louise Fraser
- Department of Neuro-Ophthalmology, Emory Eye Center, Emory University School of Medicine, Emory University, Atlanta, GA 30322, USA
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Liu ZH, Tu PH, Pai PC, Chen NY, Lee ST, Chuang CC. Predisposing factors of pituitary hemorrhage. Eur J Neurol 2011; 19:733-8. [DOI: 10.1111/j.1468-1331.2011.03619.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Kurwale NS, Ahmad F, Suri A, Kale SS, Sharma BS, Mahapatra AK, Suri V, Sharma MC. Post operative pituitary apoplexy: preoperative considerations toward preventing nightmare. Br J Neurosurg 2011; 26:59-63. [DOI: 10.3109/02688697.2011.591947] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Seuk JW, Kim CH, Yang MS, Cheong JH, Kim JM. Visual outcome after transsphenoidal surgery in patients with pituitary apoplexy. J Korean Neurosurg Soc 2011; 49:339-44. [PMID: 21887391 DOI: 10.3340/jkns.2011.49.6.339] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2010] [Revised: 04/06/2011] [Accepted: 05/30/2011] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE Pituitary apoplexy is one of the most serious life-threatening complications of pituitary adenoma. The purpose of this study is to investigate the visual outcome after early transsphenoidal surgery for the patients with pituitary apoplexy. METHODS We retrospectively reviewed the 31 patients with pituitary apoplexy who were admitted due to acute visual acuity or field impairment and treated by transsphenoidal surgery. Five patients were excluded because of the decreased conscious level. The visual acuity of each individual eye was evaluated by Snellen's chart. Visual fields were also checked using automated perimetry. To compare the visual outcome according to the surgical timing, we divided the patients into 2 groups. The first group, 21 of the patients have been undertaken transsphenoidal approach (TSA) within at least 48 hours after admission. The second group included 8 patients who have been undertaken TSA beyond 48 hours. All patients were monitored at least 12 months after surgery. RESULTS Patients were 21 males and 8 females (M : F=2.6 : 1) with the mean age of 42.4 years. Among the enrolled 29 patients, 26 patients presented with decreased visual acuity and 23 patients revealed the defective visual field respectively. Postoperatively, improvement in the visual acuity was seen in 15 patients (83.3%) who underwent surgery within the first 48 hours of presentation, as compared to those in whom surgery was delayed beyond 48 hours (n=5; 62.5%) (p=0.014). Improvement in the visual field deficits was observed in 15 (88.2%) of patients who had been operated on within the first 48 hours of presentation, as compared to those in whom surgery was delayed beyond 48 hours (n=3; 50.0%) (p=0.037). CONCLUSION This study suggests that rapid transsphenoidal surgery is effective to recover the visual impairment in patients with pituitary apoplexy. If there are associated abnormalities of visual acuity or visual fields in patients with hemorrhagic pituitary apoplexy, early neurosurgical intervention within 48 hours should be also required to recover visual impairment.
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Affiliation(s)
- Ju-Wan Seuk
- Department of Neurosurgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea
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Santos ABA, França MM, Hirosawa RM, Marivo M, Zanini MA, Nunes VS. Conservative management of pituitary tumor apoplexy. ACTA ACUST UNITED AC 2011; 55:345-8. [DOI: 10.1590/s0004-27302011000500008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Harris SM, Cannon JE, Carroll PV, Thomas SM. Pituitary apoplexy: two very different presentations with one unifying diagnosis. JRSM SHORT REPORTS 2010; 1:53. [PMID: 21234116 PMCID: PMC2994350 DOI: 10.1258/shorts.2010.100073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Sophie M Harris
- Department of Endocrinology, Guy's and St Thomas' NHS Foundation Trust , Westminster Bridge Road, London SE1 7EH , UK
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Sahin SB, Cetinkalp S, Erdogan M, Cavdar U, Duygulu G, Saygili F, Yilmaz C, Ozgen AG. Pituitary apoplexy in an adrenocorticotropin-producing pituitary macroadenoma. Endocrine 2010; 38:143-6. [PMID: 21046475 DOI: 10.1007/s12020-010-9367-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2010] [Accepted: 06/28/2010] [Indexed: 10/19/2022]
Abstract
Adrenocorticotropin (ACTH) producing macroadenomas and pituitary apoplexy are unusual in Cushing' s disease. A 20-year-old man who had been diagnosed Cushing' s disease 2 months ago, presented with sudden headache, nausea, and vomiting. His serum cortisol level was 0.4 μg/dl and ACTH level was 23.9 pg/ml. Magnetic resonance imaging of the pituitary gland disclosed a hemorrhage in the pituitary macroadenoma (22×19 mm). He was treated with IV methylprednisolone immediately and then the symptoms were relieved within the first day of the treatment. The hemorrhagic lesion was resected by transsphenoidal surgery successfully. Impaired secretion of pituitary hormones may be seen after the pituitary apoplexy. We communicate a case with pituitary apoplexy of an ACTH secreting pituitary macroadenoma, causing acute glucocorticoid insufficiency.
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Affiliation(s)
- Serap Baydur Sahin
- Department of Endocrinology and Metabolism Disease, Ege University Medical School, 35100, Izmir, Turkey.
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Zhang X, Zhang W, Fu LA, Cheng JX, Liu BL, Cao WD, Fei Z, Zhang JN, Liu WP, Zhen HN. Hemorrhagic pituitary macroadenoma: characteristics, endoscopic endonasal transsphenoidal surgery, and outcomes. Ann Surg Oncol 2010; 18:246-52. [PMID: 20703818 DOI: 10.1245/s10434-010-1243-5] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Indexed: 11/18/2022]
Abstract
PURPOSE This study aims to assess the effect of endoscopic endonasal transsphenoidal surgery (EETSS) of hemorrhagic pituitary macroadenoma (HPMA). PATIENTS AND METHODS We retrospectively reviewed 52 cases with HPMA collected from the Xijing Hospital from April 1995 to April 2009. There were 39 males and 13 females, ranging in age from 18 to 79 years (average 51.6 years). Patients presented with headache or acute ophthalmological symptoms after adenoma hemorrhage. Computed tomography (CT) scan and magnetic resonance imaging (MRI) showed pituitary macroadenoma with hemorrhage in all cases. Twenty-eight adenomas showed marked suprasellar extension, 19 showed moderate extension, and another 5 showed slight extension. All patients were promptly treated by emergency EETSS, usually within 24 h after hospitalization. RESULTS Total removal of tumor was achieved in 46 cases (88.5%), and subtotal removal in 6 cases (11.5%). Postoperative radiotherapy and reoperation of the tumor were required in five patients with either residual or relapsed tumors. Follow-up ranged from 8 to 93 months (mean 41.6 months) for 43 cases. Visual acuity and visual field recovery and improvement was recorded in 92.1% and 94.3% of patients who had preoperative visual symptoms, respectively. CONCLUSIONS The majority of macroadenomas are hemorrhagic, and they often occur in middle-aged, male subjects. Detection by imaging in the setting of pituitary apoplexy accurately predicts the nature of the apoplectic process and helps to guide the type and timing of surgery. Early EETSS is the most effective therapy and significantly improves visual outcomes and systemic conditions.
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Affiliation(s)
- Xiang Zhang
- Department of Neurosurgery, Xijing Hospital, Fourth Military Medical University, Xi'an, Shaanxi Province, People's Republic of China.
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Haboubi H, Azam I, Edavalath M, Redfern RM, Price DE, Stephens JW. Apoplexy in a corticotrophin-secreting pituitary macroadenoma: a case report and review of the literature. QJM 2010; 103:607-9. [PMID: 20085992 DOI: 10.1093/qjmed/hcp197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H Haboubi
- Department of Diabetes & Endocrinology, Swansea University, Singleton Park, Swansea SA2 8PP, UK
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Takeda N, Fujita K, Katayama S, Akutu N, Hayashi S, Kohmura E. Effect of transsphenoidal surgery on decreased visual acuity caused by pituitary apoplexy. Pituitary 2010; 13:154-9. [PMID: 20052551 DOI: 10.1007/s11102-009-0216-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We treated 12 patients with pituitary apoplexy out of 103 patients with pituitary tumors from August 1994 to March 2008 in the Nishi-Kobe Medical Center. The male to female ratio was 1:2 and the average age was 43 years old, ranging from 19 to 73. The symptoms on presentation were a decrease of visual acuity in nine, headache in seven, endocrinological disturbance in six, visual field defect in seven, a febrile state in six, vomiting in four, oculomotor disturbance in two, abducens palsy in one, and transient altered consciousness in one. All patients underwent transsphenoidal surgery and, in four of these, surgery was conducted within 7 days after onset. All nine patients with a decrease in the visual acuity recovered (100%) and, in addition, complete or near-complete vision recovery was noted in six out of eight patients (75%), excluding one patient whom we were unable to examine accurately. Emergent surgery was performed for only two patients with an acute deterioration of the visual acuity, with one finally developing complete blindness. Based on this study, we conclude that decompressive surgery is very useful for decreased visual acuity caused by pituitary apoplexy, but it is not necessary to perform emergent surgery for pituitary apoplexy in the absence of severe visual deterioration.
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Affiliation(s)
- Naoya Takeda
- Department of Neurosurgery, Nishi-Kobe Medical Center, Nishi-ku, Kobe City, Japan.
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Touqmatchi D, Chatterjee J, Tayob Y. A rare cause of postpartum headache. J OBSTET GYNAECOL 2010; 30:411-2. [PMID: 20455731 DOI: 10.3109/01443611003706902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- D Touqmatchi
- Department of Obstetrics and Gynaecology, Queen Charlotte and Chelsea Hospital, UK
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Liu ZH, Chang CN, Pai PC, Wei KC, Jung SM, Chen NY, Chuang CC. Clinical features and surgical outcome of clinical and subclinical pituitary apoplexy. J Clin Neurosci 2010; 17:694-9. [PMID: 20400318 DOI: 10.1016/j.jocn.2009.11.012] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2009] [Revised: 11/27/2009] [Accepted: 11/30/2009] [Indexed: 11/17/2022]
Abstract
The clinical features of pituitary hemorrhage vary from asymptomatic to catastrophic. Clinical symptomatic pituitary apoplexy is a well-described syndrome characterized by sudden headaches, visual impairment, hypopituitarism and, at times, impaired consciousness. Subclinical pituitary apoplexy is characterized by minimal atypical clinical manifestations and, as a result, may be misdiagnosed or inappropriately treated. The purpose of the study was to evaluate the clinical manifestations, surgical outcome and post-operative pituitary function in patients who had clinical or subclinical pituitary apoplexy. We retrospectively identified 65 patients (30 men, 35 women; age range 21-87 years, mean age 48.4 years) who underwent transsphenoidal surgery. Of these, 25 patients were diagnosed as having clinical apoplexy, while the remaining 40 patients were classified as having subclinical pituitary apoplexy. The follow-up period ranged from 21 to 73 months (mean 44 months). Vision improved in 14 of 22 patients with clinical apoplexy (64%) and in 26 of 28 patients with subclinical apoplexy (93%) (p=0.017); the total resection rate was 57% and 42%, respectively (p=0.285). After 2 years of follow-up, hormone replacement therapy was needed in only 26% and 36% of patients, respectively (p=0.149). Our findings suggest that the incidence of subclinical pituitary apoplexy is higher than that of clinical pituitary apoplexy. Both the tumor resection rate and mean age were higher in those with clinical pituitary apoplexy, while those who had subclinical pituitary apoplexy demonstrated better visual improvement. During long-term follow-up, the need for hormonal replacement decreased in both groups.
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Affiliation(s)
- Zhuo Hao Liu
- Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung Medical College and University, 5 Fu-Shin Street, Kwei-Shan Hsiang, Taoyuan Hsien 333, Taiwan
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Goel V, Debnath UK, Singh J, Brydon HL. Pituitary apoplexy after joint arthroplasty. J Arthroplasty 2009; 24:826.e7-10. [PMID: 18947970 DOI: 10.1016/j.arth.2008.06.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2007] [Revised: 04/27/2008] [Accepted: 06/04/2008] [Indexed: 02/01/2023] Open
Abstract
Pituitary apoplexy is a rare but potentially life-threatening condition caused by the sudden enlargement of a pituitary adenoma secondary to infarction and hemorrhage. The clinical syndrome is characterized by sudden onset of headache, ocular palsies, visual disturbances, and altered state of consciousness. We report 2 patients who had postoperative pituitary apoplexy after total hip and total knee arthroplasty. Asymptomatic pituitary adenomas are difficult to diagnose preoperatively. Its existence is an unlikely suspect until the clinical symptoms develop after surgery. This is the first reported case following total hip arthroplasty.
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Affiliation(s)
- Vivek Goel
- Department of Trauma and Orthopaedics, Royal Gwent Hospital, Newport, United Kingdom
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[Pituitary apoplexy and severe bilateral visual loss: a case report]. J Fr Ophtalmol 2009; 32:572-6. [PMID: 19616868 DOI: 10.1016/j.jfo.2009.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2008] [Accepted: 04/18/2009] [Indexed: 11/23/2022]
Abstract
UNLABELLED Pituitary apoplexy is caused by an infarction or a hemorrhage in a pituitary adenoma manifesting in acute headaches, consciousness impairment, endocrine features, and moderate to severe visual loss, with chiasmal syndrome or oculomotor palsies. We present a case report and a review of the literature. CASE-REPORT We report the case of a 31-year-old man who neglected bitemporal visual loss (less than 1/10 OD and 2/10 OS). Emergency cerebral tomodensitometry found a pituitary apoplexy. Visual field loss was nearly complete at OD and temporal hemianopia was present at OS. These ocular complications led to a neurosurgical transsphenoidal resection of the necrotic adenoma. Follow-up was satisfactory with complete recovery of visual acuity and visual field. DISCUSSION In the literature, headaches are present in 76% of the patients, visual loss in 62%, and ocular motor nerve palsy in 40%. Third cranial nerve palsies are predominant. CONCLUSION The clinical picture of pituitary apoplexy is characterized by the sudden onset of oculomotor palsy or blindness with acute headaches and even consciousness impairment. A functional and vital risk is present because of acute hypopituitarism. This emergency diagnosis is confirmed by tomodensitometry or magnetic resonance imaging. The association of hormone substitution and tumor transsphenoidal resection commonly leads to a positive outcome and visual improvement.
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Nawar RN, AbdelMannan D, Selman WR, Arafah BM. Pituitary tumor apoplexy: a review. J Intensive Care Med 2008; 23:75-90. [PMID: 18372348 DOI: 10.1177/0885066607312992] [Citation(s) in RCA: 167] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pituitary tumor apoplexy is an uncommon syndrome resulting often spontaneously from hemorrhage or infarction of a pre-existing pituitary adenoma. As the primary event involves the adenoma, the syndrome should be referred to as pituitary tumor apoplexy and not as pituitary apoplexy. The sudden increase in sellar contents compresses surrounding structures and portal vessels, resulting in sudden, severe headache, visual disturbances, and impairment in pituitary function. Initial management of patients with pituitary tumor apoplexy includes supportive therapy (intravenous fluids and corticosteroids), following which many patients exhibit clinical improvement. Because those patients can be effectively managed with supportive measures, many who remain clinically and neurologically unstable might benefit from urgent surgical decompression by an experienced neurosurgeon. All patients presenting with this syndrome require long-term follow-up to treat any residual tumor and/or pituitary dysfunction. Close interaction between members of the management team is necessary for optimal patients' outcome.
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Affiliation(s)
- Rita N Nawar
- Division of Clinical and Molecular Endocrinology, University Hospitals Case Medical Center, Cleveland, Ohio, USA
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Silva CMDS, Lima GAB, Machado EO, Van Haute FRB, Gadelha MR. Transient central diabetes insipidus followed by pituitary apoplexy treated in a conservative way. ARQUIVOS DE NEURO-PSIQUIATRIA 2008; 66:415-7. [DOI: 10.1590/s0004-282x2008000300028] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ducarme G, Châtel P, Luton D. [Postpartum endocrine syndrome]. JOURNAL DE GYNECOLOGIE, OBSTETRIQUE ET BIOLOGIE DE LA REPRODUCTION 2008; 37:223-228. [PMID: 18314279 DOI: 10.1016/j.jgyn.2008.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2007] [Revised: 01/09/2008] [Accepted: 01/16/2008] [Indexed: 05/26/2023]
Abstract
Postpartum endocrine syndromes occur in the year after delivery. They are due to immunologic and vascular modifications during pregnancy. The Sheehan syndrome is the first described postpartum endocrine syndrome and consists on a hypophyse necrosis in relation with a hypovolemic shock during delivery. The immunologic consequences of the pregnancy are the most frequent, sometimes discrete and transitory. The physiological evolution of the endocrine glands during pregnancy and the most frequent post-partum endocrine syndromes are discussed: postpartum lymphocytic hypophysitis, thyroiditis and Sheehan' syndrome.
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Affiliation(s)
- G Ducarme
- Service de gynécologie obstétrique, hôpital Beaujon, Assistance publique-hôpitaux de Paris (AP-HP), université Paris-7, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
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Abstract
Sellar masses are associated most commonly with pituitary adenomas. Many other neoplastic, inflammatory, infectious, and vascular lesions, however, may affect the sellar region and mimic pituitary tumors. These lesions must be considered in a differential diagnosis. This article describes the characteristics of rare sellar masses that provide clues to their differential diagnosis.
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Affiliation(s)
- Andrea Glezer
- Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of Sao Paulo Medical School, Avenida 9 de Julho, 3858 CEP 01406-100 Sao Paulo - SP, Brazil
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Hands KE, Alvarez A, Bruder JM. Gonadotropin-releasing hormone agonist-induced pituitary apoplexy in treatment of prostate cancer: case report and review of literature. Endocr Pract 2008; 13:642-6. [PMID: 17954421 DOI: 10.4158/ep.13.6.642] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To describe a case and review the literature on the rare complication of pituitary apoplexy after administration of a gonadotropin-releasing hormone agonist (GnRHa) for treatment of patients with prostate cancer. METHODS We present a detailed case report of a patient with immediate signs of pituitary apoplexy after receiving a GnRHa and review the 6 previously reported cases in the literature. A 60-year-old man presented to a local hospital with severe headache, nausea, vomiting, and diplopia. Prostate cancer had recently been diagnosed, and he had received his first dose of a GnRHa 4 hours before this presentation. On physical examination, he was confused and had ptosis of the left eye. A head computed tomographic scan without contrast enhancement showed soft tissue filling the sella, without intracranial hemorrhage or mass effect. He was discharged with the diagnosis of viral meningitis. Three weeks later, he presented again with severe headache and diplopia. He had confusion, lethargy, disorientation, a blood pressure of 88/64 mm Hg, and left cranial nerve III, IV, and VI paralysis. Magnetic resonance imaging of the brain revealed an enhancing pituitary mass with hemorrhage extending to the optic chiasm, consistent with pituitary apoplexy. Laboratory results were consistent with panhypopituitarism. Surgical excision revealed a necrotic pituitary macroadenoma with hemorrhage. Tumor immunohistochemical staining was positive only for luteinizing hormone. CONCLUSION We describe a rare adverse effect of GnRHa therapy, which unmasked a gonadotropin-secreting pituitary macroadenoma. This case adds to the 6 previously reported cases of GnRHa administration inducing pituitary apoplexy in men with prostate cancer.
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Affiliation(s)
- Kathleen E Hands
- Department of Medicine, Division of Diabetes, University of Texas Health Science Center at San Antonio, San Antonio, Texas, USA
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Balarini Lima GA, Machado EDO, Dos Santos Silva CM, Filho PN, Gadelha MR. Pituitary apoplexy during treatment of cystic macroprolactinomas with cabergoline. Pituitary 2008; 11:287-92. [PMID: 17570067 DOI: 10.1007/s11102-007-0046-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Pituitary apoplexy is a rare and life-threatening clinical condition caused by hemorrhage and/or infarction of the pituitary gland or adenoma. Although pituitary apoplexy is usually spontaneous, it has been associated with numerous precipitating factors, such as bromocriptine use. However, reports of pituitary apoplexy during cabergoline therapy are scarce. We report three patients with cystic macroprolactinomas who developed pituitary apoplexy during cabergoline treatment.
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Affiliation(s)
- Giovanna Aparecida Balarini Lima
- Division of Endocrinology, Clementino Fraga Filho University Hospital/Federal University of Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, no. 255, Cidade Universitária - Ilha do Fundão, Rio de Janeiro, RJ, Brazil
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Zhang X, Fei Z, Zhang W, Cao WD, Liu WP, Zhang JN, Fu LA, Jiang XF, Zhen HN, Song SJ, Li X. Emergency transsphenoidal surgery for hemorrhagic pituitary adenomas. Surg Oncol 2007; 16:115-20. [PMID: 17643985 DOI: 10.1016/j.suronc.2007.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2007] [Revised: 05/28/2007] [Accepted: 06/05/2007] [Indexed: 11/27/2022]
Abstract
Hemorrhagic pituitary adenoma (HPA) is an acute clinical event in neurosurgery. Emergency surgical decompression is the most effective treatment. We retrospectively reviewed 65 cases collected from the Xijing Institute of Clinical Neuroscience from 1995 to 2005 with HPA. The majority of the patients (81.5%) experienced the acute symptoms of pituitary apoplexy including headache, ocular paresis, visual field deficits and hypopituitarism. On imaging features, 34 adenomas (52.3%) showed marked suprasellar extension, 17 (26.2%) showed moderate extension, and 6 (9.2%) had slight extension, another eight (12.3%) were intrasellar. All patients were treated promptly by emergency surgical decompression usually within 24h after the hospitalization. Twenty four patients operated on by the traditional transsphenoidal microsurgery; whereas 41 patients operated on by the endoscopic endonasal transsphenoidal surgery. Total removal of tumors was achieved in 59 cases (90.8%) and subtotal removal in 6 cases (9.2%). Postoperative radiotherapy, suppressive drug therapy and endocrine replacement therapy were required in seven patients with either remaining tumor or tumor recurrence. In a median follow-up period of 49 months for 54 cases, most patients' clinical symptoms had markedly improved. Visual acuity and visual fields improved in 88.4% and 92.7% of the patients who had preoperative visual symptoms, respectively. The majority of the HPA often occurred in patients with macroadenomas. With emergency surgical treatment, most patients with HPA could have quick improvement of symptoms, especially for altered consciousness and visual acuity or visual fields impairments.
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Affiliation(s)
- Xiang Zhang
- Department of Neurosurgery, Xijing Institute of Clinical Neuroscience, Fourth Military Medical University, Xi'an, PR China.
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Rennert J, Doerfler A. Imaging of sellar and parasellar lesions. Clin Neurol Neurosurg 2006; 109:111-24. [PMID: 17126479 DOI: 10.1016/j.clineuro.2006.11.001] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2006] [Revised: 10/30/2006] [Accepted: 11/01/2006] [Indexed: 11/16/2022]
Abstract
The sellar and parasellar region is an anatomically complex area where a number of neoplastic, infectious, inflammatory, developmental and vascular pathologies can occur. Differentiation among various etiologies may not always be easy, since many of these lesions may mimic the clinical, endocrinologic and radiologic presentations of pituitary adenomas. The diagnosis of sellar lesions involves a multidisciplinary effort, and detailed endocrinologic, ophthalmologic and neurologic testing are essential. CT and, mainly, MRI are the imaging modalities to study and characterise normal anatomy and the majority of pathologic processes in this region. We here provide an overview of the most relevant MRI and CT characteristics together with clinical findings of pituitary tumors, vascular, inflammatory and infectious lesions found in the sellar/parasellar region in order to propose an appropriate differential diagnosis.
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Affiliation(s)
- Janine Rennert
- Department of Neuroradiology, University Hospital of Erlangen Medical School, University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany.
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Shahlaie K, Olaya JE, Hartman J, Watson JC. Pituitary apoplexy associated with anterior communicating artery aneurysm and aberrant blood supply. J Clin Neurosci 2006; 13:1057-62. [PMID: 17071092 DOI: 10.1016/j.jocn.2006.01.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2005] [Accepted: 01/17/2006] [Indexed: 11/18/2022]
Abstract
Pituitary apoplexy is an uncommon condition typically caused by acute, hemorrhagic expansion of the pituitary gland in patients with an adenoma that undergoes infarction. Although various risk factors have been described, the vascular events leading to apoplexy are not well understood. Disruption of microvascular blood flow is a well-known cause of morbidity from hemorrhage of an intracranial aneurysm, but pituitary apoplexy is rarely associated with aneurysmal subarachnoid hemorrhage. We report here a 46-year-old woman with pituitary apoplexy who developed subarachnoid hemorrhage from rupture of an anterior communicating artery aneurysm. Intraoperatively, she was found to have an unusual, large recurrent artery originating at the junction of the aneurysm and the A2 segment of the anterior cerebral artery that traveled to the suprasellar cistern and along the pituitary stalk. This recurrent hypophyseal artery established a direct vascular relationship between an intracerebral aneurysm and the pituitary gland.
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Affiliation(s)
- Kiarash Shahlaie
- Department of Neurological Surgery, University of California at Davis Medical Center, Sacramento, California, USA
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Semple PL, De Villiers JC, Bowen RM, Lopes MBS, Laws ER. Pituitary apoplexy: do histological features influence the clinical presentation and outcome? J Neurosurg 2006; 104:931-7. [PMID: 16776337 DOI: 10.3171/jns.2006.104.6.931] [Citation(s) in RCA: 53] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT A retrospective analysis of a contemporary series of patients with pituitary apoplexy was performed to ascertain whether the histopathological features influence the clinical presentation or the outcome. METHODS A retrospective analysis was performed in 59 patients treated for pituitary apoplexy at the University of Virginia Health System, Charlottesville, Virginia, or Groote Schuur Hospital, University of Cape Town, South Africa. The patients were divided into two groups according to the histological features of their disease: one group with infarction alone, comprising 22 patients; and the other with hemorrhagic infarction and/or frank hemorrhage, comprising 37 patients. The presenting symptoms, clinical features, endocrinological status, and outcome were compared between the two groups. CONCLUSIONS The patients who presented with histological features of pituitary tumor infarction alone had less severe clinical features on presentation, a longer course prior to presentation, and a better outcome than those presenting with hemorrhagic infarction or frank hemorrhage. The endocrine replacement requirements were similar in both groups.
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Affiliation(s)
- Patrick L Semple
- Division of Neurosurgery, Department of Pathology, Groote Schuur Hospital, University of Cape Town, South Africa
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Zayour DH, Azar ST. Silent Pituitary Infarction After Coronary Artery Bypass Grafting Procedure: Case Report and Review of Literature. Endocr Pract 2006; 12:59-62. [PMID: 16524865 DOI: 10.4158/ep.12.1.59] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To report a case of silent pituitary infarction that occurred after a coronary artery bypass grafting procedure and review the relevant literature. METHODS We describe a female patient with silent pituitary infarction several months after a coronary artery bypass operation and discuss her presentation, clinical findings, and laboratory evaluation. We also review similar cases in the literature. RESULTS A 73-year-old woman presented with generalized fatigue, weakness, and an elevated creatine kinase level several months after she had undergone a coronary artery bypass procedure. The findings on laboratory evaluation were consistent with hypogonadism, growth hormone deficiency, central hypothyroidism, and adrenal insufficiency. Magnetic resonance imaging of the pituitary fossa showed an empty sella turcica and no sellar enlargement. The patient had no headaches, no neuro-ophthalmologic symptoms, and no focal neurologic deficits. The presentation was slow and insidious. The patient received glucocorticoid and thyroid hormone replacement therapy, after which her clinical status improved substantially. Silent pituitary infarction after coronary artery bypass grafting has been reported previously in 3 male patients, but our current case is the first such report in a female patient. CONCLUSION Silent pituitary infarction can be a complication of a coronary artery bypass grafting procedure, with a delayed and insidious presentation.
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Affiliation(s)
- Dany H Zayour
- Division of Endocrinology, Beirut Governmental University Hospital, Beirut, Lebanon
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Abstract
Autoimmune (lymphocytic) hypophysitis is a rare disease that should be considered in the differential diagnosis of any nonsecreting pituitary mass, especially when occurring during pregnancy or postpartum. We have analyzed 370 articles published from January 1962 to October 2004 and identified a total of 379 patients with primary lymphocytic hypophysitis. The present review synthesizes the clinical and research data reported in this body of scientific literature.
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Affiliation(s)
- Patrizio Caturegli
- Johns Hopkins Pathology, Ross 656, 720 Rutland Avenue, Baltimore, MD 21205, USA.
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