Conservative management of pituitary tumor apoplexy

Santos, Antonio Benigno Araújo; França, Mariana M.; Hirosawa, Renata M.; Marivo, Mônica; Zanini, Marco Antônio; Nunes, Vânia dos Santos

doi:10.1590/s0004-27302011000500008

Cited by 9 publications

(4 citation statements)

References 11 publications

(12 reference statements)

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“…Indeed, early surgery is considered necessary in patients with consciousness state deterioration or in case of severe visual loss for optic chiasm compression. Nevertheless, increasing evidences show that a more conservative management can ensure favourable neuroophthalmological and endocrinological outcomes, at least in patients with moderate or spontaneous remission of visual impairment [56, 87–91]. In these cases, hydrocortisone administration (100–200 mg in bolus) is indicated also when signs or symptoms of hypoadrenalism are absent.…”

Section: Therapeutic Strategiesmentioning

confidence: 99%

Multidisciplinary Management of Pituitary Apoplexy

Albani

Ferraú

Angileri

et al. 2016

International Journal of Endocrinology

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Pituitary apoplexy is a rare clinical syndrome due to ischemic or haemorrhagic necrosis of the pituitary gland which complicates 2–12% of pituitary tumours, especially nonfunctioning adenomas. In many cases, it results in severe neurological, ophthalmological, and endocrinological consequences and may require prompt surgical decompression. Pituitary apoplexy represents a rare medical emergency that necessitates a multidisciplinary approach. Modalities of treatment and times of intervention are still largely debated. Therefore, the management of patients with pituitary apoplexy is often empirically individualized and clinical outcome is inevitably related to the multidisciplinary team's skills and experience. This review aims to highlight the importance of a multidisciplinary approach in the management of pituitary apoplexy and to discuss modalities of presentation, treatment, and times of intervention.

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Section: Therapeutic Strategiesmentioning

confidence: 99%

Multidisciplinary Management of Pituitary Apoplexy

Albani

Ferraú

Angileri

et al. 2016

International Journal of Endocrinology

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“…Immediate neurosurgical intervention is not mandatory in all patients, and the decision must be individualized. Several reports showed that conservative management can lead to a complete recovery of apoplexy in some cases (16).…”

Section: Discussionmentioning

confidence: 99%

Spontaneous remission of acromegaly: apoplexy mimicking meningitis or meningitis as a cause of apoplexy?

Villar-Taibo

Ballesteros-Pomar

Vidal-Casariego

et al. 2014

Arq Bras Endocrinol Metab

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SUMMARYPituitary apoplexy is a rare but potentially life-threatening clinical syndrome characterized by ischemic infarction or hemorrhage into a pituitary tumor. The diagnosis of pituitary tumor apoplexy is frequently complicated because of the nonspecific nature of its signs and symptoms, which can mimic different neurological processes, including meningitis. Several factors have been associated with apoplexy, such as dopamine agonists, radiotherapy, or head trauma, but meningitis is a rarely reported cause. We describe the case of a 51-year-old woman with acromegaly due to a pituitary macroadenoma. Before surgical treatment, she arrived at Emergency with fever, nausea, vomiting and meningismus. Symptoms and laboratory tests suggested bacterial meningitis, and antibiotic therapy was initiated, with quick improvement. A computerized tomography (CT) scan at admission did not reveal any change in pituitary adenoma, but a few weeks later, magnetic resonance imaging (MRI) showed data of pituitary apoplexy with complete disappearance of the adenoma. Currently, her acromegaly is cured, but she developed hypopituitarism and diabetes insipidus following apoplexy. We question whether she really experienced meningitis leading to apoplexy or whether apoplexy was misinterpreted as meningitis. In conclusion, the relationship between meningitis and pituitary apoplexy may be bidirectional. Apoplexy can mimic viral or bacterial meningitis, but meningitis might cause apoplexy, as well. This fact highlights the importance of differential diagnosis when evaluating patients with pituitary adenomas and acute neurological symptoms. Arq Bras Endocrinol Metab. 2014;58(1):76-80 SUMÁRIO A apoplexia é uma síndrome clínica rara, mas potencialmente fatal, caracterizada por infarto isquê-mico ou hemorragia em um tumor pituitário. O diagnóstico de apoplexia de tumor pituitário é frequentemente complicado pela natureza inespecífica dos seus sinais e sintomas, que podem simular diferentes processos neurológicos, incluindo a meningite. Vários fatores estão associados com a apoplexia, como o uso de agonistas dopaminérgicos, radioterapia ou trauma da cabeça, mas a meningite foi raramente relatada. Descrevemos o caso de uma mulher de 51 anos de idade com acromegalia por um macroadenoma pituitário. Antes do tratamento cirúrgico, ela foi trazida ao pronto--socorro com febre, náusea, vômitos e meningismo. Os sintomas e análises laboratoriais sugeriram meningite bacteriana e o tratamento com antibióticos foi iniciado, com melhora rápida dos sintomas. Uma tomografia computadorizada (CT) na admissão ao hospital não revelou nenhuma alteração no adenoma pituitário, mas algumas semanas depois uma ressonância magnética (MRI) mostrou informações de apoplexia pituitária, com desaparecimento completo do adenoma. Atualmente, a acromegalia está curada, mas ela desenvolveu hipopituitarismo e diabetes insipidus depois da apoplexia. Questionamo-nos se a paciente realmente apresentou meningite que levou à apoplexia ou se a apoplexia foi mal interpretada como sendo me...

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“…In particular, conservative management is performed in patients with mild symptoms and stable ophthalmological deficits (6,37,40,42). Many studies have demonstrated spontaneous resolution of visual and neurological symptoms with expectant management (54)(55)(56)(57). However, until now, no randomized trial has compared both strategies (35,36,39).…”

Section: Cor T1wi Sagt1wimentioning

confidence: 99%

Apoplexy in sporadic pituitary adenomas: a single referral center experience and AIP mutation analysis

Fialho¹,

Barbosa²,

Lima³

et al. 2021

Archives of Endocrinology and Metabolism

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Objective: To analyze the clinical, laboratory, and radiological findings and management of patients with clinical pituitary apoplexy and to screen for aryl hydrocarbon receptor-interacting protein (AIP) mutations. Subjects and methods: The clinical findings were collected from the medical records of consecutive sporadic pituitary adenoma patients with clinical apoplexy. Possible precipitating factors, laboratory data, magnetic resonance imaging (MRI) findings and treatment were also analyzed. Peripheral blood samples were obtained for DNA extraction from leukocytes, and the entire AIP coding region was sequenced. Results: Thirty-five patients with pituitary adenoma were included, and 23 (67%) had non-functioning pituitary adenomas. Headache was observed in 31 (89%) patients. No clear precipitating factor was identified. Hypopituitarism was observed in 14 (40%) patients. MRI from 20 patients was analyzed, and 10 (50%) maintained a hyperintense signal in MRI performed more than three weeks after pituitary apoplexy (PA). Surgery was performed in ten (28%) patients, and 25 (72%) were treated conservatively with good outcomes. No AIP mutation was found in this cohort. Conclusion:Patients with stable neuroophthalmological impairments can be treated conservatively if no significant visual loss is present. Our radiological findings suggest that hematoma absorption lasts more than that observed in other parts of the brain. Additionally, our study suggests no benefits of AIP mutation screening in sporadic patients with apoplexy.

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Conservative management of pituitary tumor apoplexy

Cited by 9 publications

References 11 publications

Multidisciplinary Management of Pituitary Apoplexy

Multidisciplinary Management of Pituitary Apoplexy

Spontaneous remission of acromegaly: apoplexy mimicking meningitis or meningitis as a cause of apoplexy?

Apoplexy in sporadic pituitary adenomas: a single referral center experience and AIP mutation analysis

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