Pituitary Apoplexy in Nonfunctioning Pituitary Macroadenomas: A Case-Control Study

Vargas, Guadalupe; González, Baldomero; Guinto, Gerardo; Mendoza, Victoria; López-Félix, Blas; Zepeda, Erick; Mercado, Moisés

doi:10.4158/ep14120.or

Cited by 38 publications

(28 citation statements)

References 28 publications

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“…[4] Panhypopituitarism, adrenal insufficiency, hypothyroidism, hypogonadism, growth hormone deficiency and diabetes insipidus may all occur as a result of pituitary apoplexy. [2,8] Fortunately, our patient did not develop any hormonal deficiency during the acute event.…”

Section: Discussionmentioning

confidence: 59%

“…[7] This entity usually manifests with ocular palsy, visual field and visual acuity disturbances, nausea, vomiting, photophobia and hypertension. [1][2][3][4][5][6][7][8][9] Apoplexy may be encountered in patients with a rapidly growing pituitary adenoma, not identified until the development of symptoms related to the former. [9] A wide range of risk factors for the development of pituitary apoplexy have been reported in the literature, with poorly controlled arterial hypertension often identified as the culprit.…”

Section: Discussionmentioning

confidence: 99%

“…[9] A wide range of risk factors for the development of pituitary apoplexy have been reported in the literature, with poorly controlled arterial hypertension often identified as the culprit. [1,4,5,8] Other potential precipitating factors include pituitary irradiation, major surgery, coagulopathies, head trauma, pregnancy, dynamic pituitary gland studies, and hormone replacement therapy, among others. Hypertension induced degenerative microvasculature alterations are known to precipitate apoplectic episodes.…”

Section: Discussionmentioning

confidence: 99%

“…Hypertension induced degenerative microvasculature alterations are known to precipitate apoplectic episodes. [1][2][3][4][5][6][7][8][9] The clinical features are quite variable. [7] Literature suggest the most commonly identified early manifestation is retro-orbital headache, as a result of stretching and irritation of the dura mater overlying the sella turcica.…”

Section: Discussionmentioning

confidence: 99%

“…[8] According to current United Kingdom guidelines for the management of pituitary apoplexy, patients with hemodynamic instability, altered visual fields, altered men-tation, and/or decreased visual acuity should be started on intravenous glucocorticoid therapy. [8] Furthermore, even if the patient is hemodynamically stable, but has serum cortisol lower than 550 mmol/L, intravenous glucocorticoids should also be considered. [8] Given that our patient remained hemodynamically stable during the admission, infusion of glucocorticoids was not required.…”

Section: Discussionmentioning

confidence: 99%

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An unrecognized endocrinology emergency masquerading as a hypertensive emergency: A can’t miss diagnosis

Vargas

Maymi

Letelier

et al. 2016

CRIM

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Pituitary apoplexy secondary to sellar tumors is a rare entity that carries a high mortality rate. It could be secondary to infarction or hemorrhage of the pituitary gland. The incidence remains unclear, most are reported in men between the ages of 50 to 60. In the majority of times, apoplexy is idiopathic in nature, without a clear discernible cause. However, there are multiple risk factors associated with this entity, such as systemic hypertension, among others. There are few cases of pituitary apoplexy caused by infarction of a pituitary macroadenoma. We present this case of pituitary apoplexy secondary to infarction of a nonfunctional pituitary adenoma in a young woman, with a fortunate resolution.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 3 more Smart Citations

An unrecognized endocrinology emergency masquerading as a hypertensive emergency: A can’t miss diagnosis

Vargas

Maymi

Letelier

et al. 2016

CRIM

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Pituitary apoplexy is associated with concurrent or subsequent diagnosis of human immunodeficiency virus

Douglas,

Salmon,

Kshirsagar

et al. 2024

World j. otorhinolaryngol.-head neck surg.

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ObjectivePituitary apoplexy (PA) is a rare condition caused by hemorrhage or infarction of the pituitary gland with associated risk of cranial neuropathies, endocrinopathies, and even death. Human immunodeficiency virus (HIV) has been shown to have some association with pituitary apoplexy, however, large‐scale studies have not been performed.MethodsA retrospective cohort study of subjects greater than 18 years of age was performed using the national TriNetX database. The general population was first compared with those undergoing treatment for PA to compare general demographics and incidence of HIV. The PA cohort was then substratified by HIV status and propensity matched by age and sex to evaluate differences in visual outcomes and endocrine metrics. Using the diagnosis of pituitary apoplexy as an index event, the rate of HIV diagnosis at the time of presentation or in the three months following treatment was calculated. Two‐tailed, unpaired t‐tests were performed.ResultsA total 2066 patients were identified (902 HIV, 1158 controls). Those with HIV showed an increased rate of pituitary apoplexy (odds ratio [OR]: 19.8) versus healthy adults and were more likely to be younger and male. Among patients treated for pituitary apoplexy, patients with HIV were more likely to have increased thyroid stimulating hormone, reduced T4, and increased prolactin compared with healthy controls. There were no significant differences in visual outcomes between HIV positive and control patients. Importantly, 74% of patients did not carry a diagnosis of HIV on presentation but were diagnosed at the time of or in the three months following treatment for pituitary apoplexy.ConclusionsDiagnosis and treatment of pituitary apoplexy shows a high rate of concurrent or subsequent diagnosis of HIV. Screening for HIV should be considered in patients undergoing treatment for pituitary apoplexy.

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Neurosurgical Emergencies

Lee¹,

Chaichana²,

Huang³

et al. 2020

Current Clinical Neurology

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Pituitary Apoplexy in Nonfunctioning Pituitary Macroadenomas: A Case-Control Study

Cited by 38 publications

References 28 publications

An unrecognized endocrinology emergency masquerading as a hypertensive emergency: A can’t miss diagnosis

An unrecognized endocrinology emergency masquerading as a hypertensive emergency: A can’t miss diagnosis

Pituitary apoplexy is associated with concurrent or subsequent diagnosis of human immunodeficiency virus

Neurosurgical Emergencies

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