Blindness following pituitary apoplexy: Timing of surgery and neuro-ophthalmic outcome

Muthukumar, Natarajan; Rossette, Devi; Soundaram, Meenakshisundaram; Senthilbabu, Suyambu; Badrinarayanan, Thiyagarajan

doi:10.1016/j.jocn.2007.08.010

Cited by 61 publications

(38 citation statements)

References 44 publications

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“…Postoperative hypogonadism remains in 55-79%, hypothyroidism in 45-60%, and ACTH deficiency in 40-87% of cases (2, 7, 10, 62). GH deficiency, although rarely assessed, appears to be the most common (84%) (116). Despite its high prevalence postoperatively, pituitary dysfunction is consistently reported to improve after surgery, compared with the presurgical status (2, 6, 18, 19).…”

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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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%

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

Căpățînă

Inder

Karavitaki

et al. 2015

European Journal of Endocrinology

125

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“…Preoperative preservation of at least light perception vision predicts better visual outcomes postoperatively compared with patients with absence of light perception. Muthukumar et al [18] reported four patients with monocular or bilateral no light perception vision because of pituitary apoplexy. Surgical treatment via transphenoidal approach varied from within 1 week to 2 months after ictus.…”

Section: Prognosismentioning

confidence: 99%

Pituitary apoplexy: evaluation, management, and prognosis

Murad-Kejbou

Eggenberger

2009

Current Opinion in Ophthalmology

103

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“…If there is no improvement or and deterioration of ophthalmoplegia or consciousness within seven days, emergent decompressive surgery is needed. 35,36 Twelve of the 17 patients reviewed here received surgical treatment, with transsphenoidal excision of the pituitary adenoma being the selected modality. Five patients were managed conservatively.…”

Section: Discussionmentioning

confidence: 99%