Endoscopic Endonasal Transsphenoidal Approach for the Surgical Treatment of Pituitary Apoplexy and Clinical Outcomes

Sun, Zhixiang; Cai, Xintao; Liu, Yu; Shao, Dongqi; Jiang, Zhiquan

doi:10.1177/15330338211043032

Cited by 4 publications

(3 citation statements)

References 35 publications

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“…Other signs and symptoms at PA presentation include lactotroph PitNET-associated galactorrhea [ 141 , 174 , 183 ]; hyperthermia [ 180 ], pruritic skin rash associated with central adrenal insufficiency-related cortisol deficit [ 185 ], hiccups [ 109 ], epistaxis [ 91 ], hematuria [ 189 ], phonophobia [ 78 ], visual illusions [ 45 ], and symptomatic diabetic ketoacidosis [ 53 , 171 , 172 ].…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

“…In terms of the PitNET stain profile (regardless clinical expression) non-functional type was followed by somatotroph PitNETs [ 32 , 38 , 42 , 46 , 53 , 56 , 66 , 76 , 78 , 86 , 92 , 93 , 98 , 100 , 108 , 109 , 121 , 128 , 136 , 141 , 148 , 152 , 156 , 166 , 168 , 169 , 171 , 175 , 192 , 217 ], lactotroph PitNETs [ 66 , 75 , 77 , 90 , 98 , 100 , 113 , 121 , 126 , 128 , 141 , 166 , 168 , 169 , 174 , 175 , 183 , 202 , 206 ], gonadotroph PitNETs […”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

“…Another study included 49 subjects who were referred for neurosurgery and 18 patients who were conservatively managed and showed similar improvement in visual and cranial nerve palsies [ 123 ]. A retrospective study (N = 24 subjects who underwent TSS) showed a complete tumor resection in 87.5% of cases; 94.44% of patients experienced an improvement of visual acuity; diabetes insipidus developed in 16.66% of individuals [ 174 ].…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

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Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

et al. 2023

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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.

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Section: Pitnet Complicated With Pamentioning

confidence: 99%

Section: Pitnet Complicated With Pamentioning

confidence: 99%

Section: Pitnet Complicated With Pamentioning

confidence: 99%

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Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

et al. 2023

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Differences in clinical, hormonal, and radiological presentation and in surgical outcomes in patients presenting with and without pituitary apoplexy. A multicenter study of 245 cases

et al. 2023

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Determinants of visual and endocrinological outcome after early endoscopic endonasal surgery for pituitary apoplexy

Galal

Ahmed

2022

Surgical Neurology International

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Background: Patients diagnosed with pituitary apoplexy and presenting with acute visual deterioration require urgent surgical resection. This is also commonly associated with pituitary hypopituitarism that requires hormonal replacement for correction. This study was undertaken to evaluate the clinical recovery of 45 patients diagnosed with symptomatic pituitary apoplexy who underwent early (within 72 h of symptom onset) endoscopic transsphenoidal surgical resection with an emphasis on visual, ocular craniopathy, and endocrinological outcome. Methods: This is a retrospective analysis of a consecutive series of patients diagnosed with pituitary apoplexy between 2011 and 2020 treated by early (within 72 h of symptom onset) endoscopic transsphenoidal surgical resection. All tumors were histologically proven as pituitary adenomas. Clinical and neuro-ophthalmological examinations, imaging studies, and endocrinological evaluation were retrospectively reviewed. Patients with a minimum of 6 months follow-up were included in the study. The influence of patients’ demographics, extent of visual and ocular motility impairment, preoperative endocrinological dysfunction, tumor size and extent, degree of resection, and surgical complications were analyzed as potential prognostic factors for recovery. Results: Forty-five patients were included in this retrospective study. Ages ranged from 27 to 57 years (mean: 42 years). All patients presented with headache and variable degrees of visual loss and visual field deficit. Ophthalmoplegia was present in 22 (48.9%) patients with 17 (37.8%) having bilateral ocular cranial nerve palsy. All patients had variable degrees of endocrinological deficiencies. All patients showed evidence of low cortisol, 14 (31.1%) showed hypothyroidism and 11 (24.4%) showed hypogonadism. There was evidence of hyperprolactinemia in 16 (35.6%) patients. All patients harbored a pituitary macroadenoma. Tumor resection was complete in 33 (73%) of patients, with residual tumor related to cavernous sinus or retrosellar extension. Operative complications were mainly related to short-term nasal complications occurring in 14 (31%) patients. Cerebrospinal fluid leak requiring revision surgery occurred in only one patient harboring a modified SIPAP Grade 3s tumor. Transient diabetes insipidus occurred in 9 (20%) patients, with 2 (4.4%) requiring long-term hormonal replacement. The mean follow-up was 25 months. Baseline visual improvement was achieved in 39 (86.7%) patients. Ocular cranial nerve palsy showed complete recovery in 17 (77.2%) patients. Endocrine follow-up showed that patients with panhypopituitarism (11 [24.4%]) failed to recover. Conclusion: The current surgical series showed safety in terms of low complication rate and efficacy in terms of clinical outcome. The significant prognostic factor related to visual recovery was the degree of preoperative visual deficit. Recovery of ocular cranial neuropathy showed a higher recovery rate when it was unilateral as opposed to bilateral. Pituitary hormonal recovery was less favorable with pituitary panhypopituitarism being a poor prognostic factor.

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Endoscopic Endonasal Transsphenoidal Approach for the Surgical Treatment of Pituitary Apoplexy and Clinical Outcomes

Cited by 4 publications

References 35 publications

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

Differences in clinical, hormonal, and radiological presentation and in surgical outcomes in patients presenting with and without pituitary apoplexy. A multicenter study of 245 cases

Determinants of visual and endocrinological outcome after early endoscopic endonasal surgery for pituitary apoplexy

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