Cushing’s disease presenting with pituitary apoplexy

Chan, D.S.H.; Rong, Teo Cheng; Dalan, Rinkoo

doi:10.1016/j.jocn.2011.10.017

Cited by 7 publications

(11 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…In accordance with medical literature, we found a male predominance (male-to-female ratio of 1.76). The mean age of patients was 50.52 years, the youngest was 9, and the oldest was 85 years [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , ...…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

“…Sudden headache was the most frequent symptom and occurred in more than two-thirds of patients. ( Table 1 ) Headache was severe, often described as the most painful headache episode an individual has ever experienced, and graded, for example, as high as 9 on a scale from 0 to 10, with 10 being the most severe in one study [ 31 ]. For practical purposes we point out that headache was absent in some cases; thus, an index of suspicion should be provided by other endocrine and non-endocrine clinical elements [ 43 , 86 , 196 , 197 , 198 , 199 , 200 , 201 , 202 , 203 , 204 , 205 , 206 , 207 , 208 , 209 , 210 , 211 , 212 , 213 , 214 , 215 , 216 ].…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

See 1 more Smart Citation

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

et al. 2023

View full text Add to dashboard Cite

Various complications of pituitary neuroendocrine tumors (PitNET) are reported, and an intratumor hemorrhage or infarct underlying pituitary apoplexy (PA) represents an uncommon, yet potentially life-threatening, feature, and thus early recognition and prompt intervention are important. Our purpose is to overview PA from clinical presentation to management and outcome. This is a narrative review of the English-language, PubMed-based original articles from 2012 to 2022 concerning PA, with the exception of pregnancy- and COVID-19-associated PA, and non-spontaneous PA (prior specific therapy for PitNET). We identified 194 original papers including 1452 patients with PA (926 males, 525 females, and one transgender male; a male-to-female ratio of 1.76; mean age at PA diagnostic of 50.52 years, the youngest being 9, the oldest being 85). Clinical presentation included severe headache in the majority of cases (but some exceptions are registered, as well); neuro-ophthalmic panel with nausea and vomiting, meningism, and cerebral ischemia; respectively, decreased visual acuity to complete blindness in two cases; visual field defects: hemianopia, cranial nerve palsies manifesting as diplopia in the majority, followed by ptosis and ophthalmoplegia (most frequent cranial nerve affected was the oculomotor nerve, and, rarely, abducens and trochlear); proptosis (N = 2 cases). Risk factors are high blood pressure followed by diabetes mellitus as the main elements. Qualitative analysis also pointed out infections, trauma, hematologic conditions (thrombocytopenia, polycythemia), Takotsubo cardiomyopathy, and T3 thyrotoxicosis. Iatrogenic elements may be classified into three main categories: medication, diagnostic tests and techniques, and surgical procedures. The first group is dominated by anticoagulant and antiplatelet drugs; additionally, at a low level of statistical evidence, we mention androgen deprivation therapy for prostate cancer, chemotherapy, thyroxine therapy, oral contraceptives, and phosphodiesterase 5 inhibitors. The second category includes a dexamethasone suppression test, clomiphene use, combined endocrine stimulation tests, and a regadenoson myocardial perfusion scan. The third category involves major surgery, laparoscopic surgery, coronary artery bypass surgery, mitral valvuloplasty, endonasal surgery, and lumbar fusion surgery in a prone position. PA in PitNETs still represents a challenging condition requiring a multidisciplinary team from first presentation to short- and long-term management. Controversies involve the specific panel of risk factors and adequate protocols with concern to neurosurgical decisions and their timing versus conservative approach. The present decade-based analysis, to our knowledge the largest so far on published cases, confirms a lack of unanimous approach and criteria of intervention, a large panel of circumstantial events, and potential triggers with different levels of statistical significance, in addition to a heterogeneous clinical picture (if any, as seen in subacute PA) and a spectrum of evolution that varies from spontaneous remission and control of PitNET-associated hormonal excess to exitus. Awareness is mandatory. A total of 25 cohorts have been published so far with more than 10 PA cases/studies, whereas the largest cohorts enrolled around 100 patients. Further studies are necessary.

show abstract

Section: Pitnet Complicated With Pamentioning

confidence: 99%

Section: Pitnet Complicated With Pamentioning

confidence: 99%

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

et al. 2023

View full text Add to dashboard Cite

show abstract

“…In the vast majority of cases, apoplexy complicates large macroadenomas [10]. Clinically silent ACTH adenomas may be particularly prone to necrosis, hemorrhage, and cyst transformation [5,60]. These complications occur in 30-64% of cases, 2-14% in patients with all types of pituitary adenoma [16,[61][62][63].…”

Section: Influence Of Pituitary Adenoma Typementioning

confidence: 99%

Pituitary Apoplexy

Jemel¹,

Alaya²,

Boubaker³

et al. 2019

Pituitary Diseases

View full text Add to dashboard Cite

Pituitary apoplexy is a rare clinical emergency due to acute ischemic infarction or hemorrhage of the pituitary gland. As this disorder most often involves a pituitary adenoma, especially nonfunctioning tumors, the syndrome should be referred to as pituitary tumor apoplexy. The precise physiopathology is not completely clear. Although in most cases it occurs spontaneously, pituitary apoplexy can be precipitated by many risk factors. The main symptom is headache of sudden onset associated with visual disturbances, signs of meningeal irritation, and/or endocrine dysfunction. Corticotropic deficiency is a potentially life-threatening disorder. Magnetic resonance imaging is the most sensitive to confirm the diagnosis by revealing a pituitary tumor with hemorrhagic and/or necrotic components. Earlier studies used to consider urgent decompression of the lesion surgically, but nowadays, more recent studies favor conservative management in selected patients (those without important visual acuity or field defects and with normal consciousness). This wait-and-see approach gives evidence of excellent outcomes in terms of oculomotor palsy, pituitary function, and subsequent tumor growth. Surgical decompression may be necessary in some cases. Once the acute phase is over, the patient should be reevaluated for hormonal deficiencies. Moreover, spontaneous remission of syndromes, such as acromegaly, may be caused by pituitary adenoma apoplexy.

show abstract

“…Endocrinologic disturbances, caused by pituitary impairment, 7,82 constitute another classic feature of the PA syndrome. 4 Of course endocrinologic symptoms due to a preexisting secreting adenoma, 8,108 such as amenorrhoea/galactorrhea syndrome, acromegalic features, 75 or Cushing's syndrome, 109 may be apparent. The most important and usually life-threatening condition in PA is the reduction of corticotropin release.…”

Section: Endocrinologic Symptomsmentioning

confidence: 99%

“…This results in cortisol deficiency symptoms, common during the acute event, 1 and even (secondary) in an Addisonian crisis (which may present with hypotension, lethargy, and fever, 27 hypoglycemia, 14,22,30 circulatory shock, and end in death 14,20,22 ). Endocrinologic conditions related to an electrolyte imbalance in PA patients include diabetes insipidus (due to hypothalamic and posterior pituitary involvement) 9,15,21,108,110 and syndrome of inappropriate secretion of antidiuretic hormone 30 with hyponatremia 14,22,87,88 causing symptoms that range from dizziness to confusion, seizures, and coma. 22,83,87,88 In cases of euvolemic hyponatremia (a common electrolyte disturbance in elderly patients visiting the emergency department), recent history of headache should raise the suspicion of PA. 87,88 Other endocrinologic symptoms that may develop include those of panhypopituitarism 1,9,21,109 including somatotrophic deficiency, 30 secondary hypothyroidism, 30,86 and myxedema, 22 as well as gonadotrophic deficiency (common) with reduced sexual drive, impotence, loss of body hair, and infertility.…”

Section: Endocrinologic Symptomsmentioning

confidence: 99%

Presenting Symptoms of Pituitary Apoplexy

Pyrgelis

Mavridis

Meliou

2017

J Neurol Surg A Cent Eur Neurosurg

View full text Add to dashboard Cite

The classical term "pituitary apoplexy" (PA) describes a clinical syndrome usually characterized by abrupt onset of headache accompanied by neurologic and/or endocrinologic deterioration due to sudden expansion of a mass within the sella turcica as a result of hemorrhage or infarction within a pituitary tumor and adjacent pituitary gland. PA is a medical emergency and a difficult diagnosis to establish. Thus this article reviews the presenting symptoms of PA patients to help clinicians recognize or at least suspect this critical condition early on. PA commonly occurs in the setting of a preexisting adenoma, and several patients are unaware of its existence prior to the onset of apoplexy symptoms, which are mainly of a neurologic, ophthalmologic, and endocrinologic nature. Neurologic symptoms include sudden-onset severe headache and other symptoms of subarachnoid hemorrhage, symptoms from compression of the cavernous sinus contents, nausea/vomiting, impaired consciousness, and symptoms of meningeal irritation. Ophthalmologic symptoms include visual field defects, visual loss, diplopia, and ophthalmoplegia. Endocrinologic disturbances include pituitary adenoma symptoms, cortisol deficiency, panhypopituitarism, diabetes insipidus, and syndrome of inappropriate secretion of antidiuretic hormone. Magnetic resonance imaging is the imaging method of choice to aid the PA diagnosis. Its differential diagnoses include cerebrovascular accidents, infectious diseases, and other causes of endocrinologic imbalance. Transsphenoidal surgery is the treatment of choice, especially if there are associated visual abnormalities and ophthalmoplegia. Clinicians should be aware of the presenting symptoms because early diagnosis may reduce the morbidity and mortality of this neurosurgical emergency.

show abstract

Cushing’s disease presenting with pituitary apoplexy

Cited by 7 publications

References 41 publications

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

Pituitary Apoplexy

Presenting Symptoms of Pituitary Apoplexy

Contact Info

Product

Resources

About