An objective scoring tool in the management of patients with pituitary apoplexy

Reddy, Narendra; Rajasekaran, Senthil; Han, Thang S.; Theodoraki, Aikaterini; Drake, Will; Vanderpump, Mark; Baldeweg, Stephanie E; Wass, John

doi:10.1111/j.1365-2265.2011.04081.x

Cited by 26 publications

(10 citation statements)

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“…In a recently published retrospective surgical series, a grading system based on clinical findings has been proposed; lower grades (1-3) were more frequently associated with complete recovery of the hypopituitarism than higher grades (4-5) (112).…”

Section: Surgerymentioning

confidence: 99%

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MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

Căpățînă

Inder

Karavitaki

et al. 2015

European Journal of Endocrinology

125

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Pituitary tumour apoplexy (PA) is a rare clinical syndrome that occurs as a result of acute haemorrhage and/or infarction within a frequently undiagnosed pituitary tumour. The sudden enlargement of the pituitary mass undergoing PA is responsible for a wide range of acute symptoms/signs (severe headache, visual loss, diplopia, hypopituitarism, impaired consciousness) which, together with the radiological evidence of a pituitary lesion, establish the diagnosis. The optimal care of PA requires involvement of a multidisciplinary team including endocrinologist, neurosurgeon, neuroophthalmologist and the management strategy that depends on the clinical manifestations, as well as the presence of co-morbidities. Prompt surgical decompression is initially indicated in cases with severe or progressive impairment of the visual acuity or the visual fields or with altered mental state and leads to visual and neurological recovery in most of the patients. The patients with mild, stable clinical picture (including those with isolated ocular palsies) can be managed conservatively (support of fluid and electrolyte balance and stress doses of steroids in most cases) with favourable visual and neurological outcome. Frequent reassessment is mandatory because the clinical course can be unpredictable; if progression of symptoms occurs, later elective surgery is indicated and is beneficial, especially in terms of visual outcome. The endocrinological outcome is less favourable, irrespective of the treatment option, with many patients remaining on long-term replacement therapy. Despite the above guidelines, clear proof of optimal outcomes in the form of randomised controlled trials is lacking. Regrowth of the pituitary tumour years after a PA episode is possible and patients require long-term surveillance.

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Section: Surgerymentioning

confidence: 99%

“…The data suggested that a PAS over four might be an argument for emergency surgery, but prospective studies are needed for further validation. Another clinical grading system with potential implications for PA management was recently developed (112).…”

Section: Surgerymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

Căpățînă

Inder

Karavitaki

et al. 2015

European Journal of Endocrinology

125

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“…Recentemente, gli stessi autori hanno anche suggerito l'adozione di uno score di valutazione del paziente con apoplessia ipofisaria in fase acuta, finalizzato all'obiettiva individuazione del miglior percorso terapeutico [12]. Esso si basa sull'attribuzione di un punteggio complessivo risultante dalla somma di 3 parametri neuro-oftalmologici-acuità visiva (grado 0, 1 o 2), presenza di deficit campimetrici (grado 0, 1 o 2) e paresi oculare (grado 0, 1 o 2)-e del Glasgow Coma Scale (grado 0, 2 o 4).…”

Section: Le Strategie Terapeuticheunclassified

L’apoplessia ipofisaria: riconoscerla rapidamente e trattarla correttamente

et al. 2014

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Sommario L'apoplessia ipofisaria rappresenta un'emergenza medico-chirurgica la cui gestione compete a un esperto team multidisciplinare composto da endocrinologi, radiologi, oculisti e neurochirurghi. Una tempestiva diagnosi e un'adeguata valutazione delle conseguenze neuro-oftalmologiche e endocrinologiche sono essenziali per l'adozione di interventi terapeutici equilibrati ed efficaci, finalizzati primariamente alla salvaguardia delle capacità visive. Il rischio di ipopituitarismo è elevato e l'iposurrenalismo in particolare svolge un ruolo cruciale sul decorso clinico.Parole chiave Ipopituitarismo · Cecità · Cefalea · Ipofisi · Apoplessia Proposta da Renato Cozzi.Materiale elettronico supplementare La versione elettronica di questo articolo (Introduzione L'apoplessia ipofisaria consiste nella necrosi, di tipo emorragico o ischemico, dell'ipofisi. In molti casi essa determina drammatiche conseguenze neurologiche, oftalmologiche ed endocrine, e può richiedere un rapido intervento decompressivo. Per tale motivo rappresenta una delle rare emergenze sanitarie che l'endocrinologo non solo deve conoscere, ma che deve soprattutto saper gestire in collaborazione con un team multidisciplinare. Il primo tumore ipofisario massivamente emorragico è stato descritto da Pearce Bailey nel 1898, ma il termine apoplessia ipofisaria è stato coniato solo nel 1950 da Brougham et al., che descrissero il conseguente quadro clinico in alcuni pazienti [1]. Tuttavia, sebbene tale evento sia conosciuto da decenni, le modalità di trattamento e i tempi di intervento sono ancora ampiamente dibattuti, anche per la carenza di specifiche linee guida. Per questo motivo la gestione del paziente con apoplessia ipofisaria è spesso individualizzata su base empirica e l'esito clinico è inevitabilmente condizionato dal livello di esperienza che un team multidisciplinare ha potuto acquisire sul campo.Un preesistente, anche se misconosciuto, tumore ipofisario (soprattutto non secernente) rappresenta il fattore predisponente della necrosi ipofisaria in circa l'80% dei pazienti. Si stima che l'incidenza di emorragia intra-lesionale nel contesto di un adenoma ipofisario sia cinque volte superiore rispetto ad altre neoplasie intracraniche. Tuttavia, l'apoplessia si può verificare anche in altre lesioni espansive dell'ipofisi, quali quelle di natura autoimmune, o addirittura in una ghiandola ipofisaria verosimilmente sana, per esempio in corso di gravi eventi ipovolemici durante il parto o il puerperio (Sindrome di Sheehan) [2]. Secondo dati di letteratura, almeno un quarto dei pazienti che sono andati incontro ad apoplessia ipofisaria soffriva di ipertensione arteriosa o aveva fatto recente uso di farmaci anticoagulanti o

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“…PAS can also be a useful tool to monitor patient being managed conservatively and progressive increase in the score during the period of observation may prompt consideration for surgery. [25] However, as suggested by the UK guideline development group, clinical outcomes of management decisions based on PAS needs validation by prospective studies.…”

Section: Pitutary Apoplexy Score (Pas)mentioning

confidence: 99%

Online risk engines and scoring tools in endocrinology

Chakraborty

Ghosh

Kalra

2013

Indian J Endocr Metab

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With evolution of evidence-based medicine, risk prediction equations have been formulated and validated. Such risk engines and scoring systems are able to predict disease outcome and risks of possible complications with varying degrees of accuracy. From health policy makers point of view it helps in appropriate disbursement of available resources for greatest benefit of population at risk. Understandably, the accuracy of prediction of different risk engines and scoring systems are highly variable and has several limitations. Each risk engine or clinical scoring tool is derived from data obtained from a particular population and its results are not generalizable and hence its ability to predict risk/outcome in a different population with differences in ethnicity, ages, and differences in distribution of risk factors over time both within and between populations. These scoring systems and risk engines to begin with were available for manual calculations and references/use of formula and paper charts were essential. However, with evolution of information technology such calculations became easier to make with use of online web-based tools. In recent times with advancement of android technology, easy to download apps (applications) has helped further to have the benefits of these online risk engines and scoring systems at our finger tips.

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An objective scoring tool in the management of patients with pituitary apoplexy

Cited by 26 publications

References 1 publication

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

L’apoplessia ipofisaria: riconoscerla rapidamente e trattarla correttamente

Online risk engines and scoring tools in endocrinology

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