Fatal postoperative 'pituitary apoplexy': its cause and management

Goel, Meenu

doi:10.1080/02688699550041728

Cited by 56 publications

(14 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A similar association was indicated by Younus et al and was supported by the fact that several studies examining postoperative pituitary apoplexy were either performed in patients with giant adenomas or similarly found an association with tumor size. 15,17,18 Larger tumors may also represent a more aggressive pathology that would carry increased probability of invading the cavernous sinus, a finding that trended toward significance on our univariable analysis as well ( P = .063). Although STR may appear to be an individual risk factor for SPH status and the true mechanism behind SPH is still unknown, physicians should align their concerns with patients who have larger adenomas, where both STR and SPH are likely.…”

Section: Discussionmentioning

confidence: 68%

Risk Factors for Significant Postoperative Hemorrhage After Pituitary Neuroendocrine Tumor Resection: A Case-Control Study of 1066 Surgeries

et al. 2023

View full text Add to dashboard Cite

BACKGROUND: Postoperative hemorrhage is a rare but potentially serious complication after pituitary surgery. The risk factors for this complication are mostly unknown, and further knowledge would help guide postoperative management. OBJECTIVE: To investigate the perioperative risks and clinical presentation of significant postoperative hemorrhage (SPH) after endonasal surgery for pituitary neuroendocrine tumors. METHODS: A population of 1066 patients undergoing endonasal (microscopic and endoscopic) surgery for pituitary neuroendocrine tumor resection at a high-volume academic center was reviewed. SPH cases were defined as postoperative hematoma evident on imaging requiring return to the operating room for evacuation. Patient and tumor characteristics were analyzed with uni-and multivariable logistic regression, and postoperative courses were descriptively examined. RESULTS: Ten patients were found to have SPH. On univariable analysis, these cases were significantly more likely to present with apoplexy (P = .004), have larger tumors (P < .001), and lower gross total resection rates (P = .019). A multivariate regression analysis showed that tumor size (odds ratio 1.94, P = .008) and apoplexy at presentation (odds ratio 6.00, P = .018) were significantly associated with higher odds of SPH. The most common symptoms for patients with SPH were vision deficits and headache, and the median time for symptom onset was 1 day after surgery. CONCLUSION: Larger tumor size and presentation with apoplexy were associated with clinically significant postoperative hemorrhage. Patients presenting with pituitary apoplexy are more likely to experience a significant postoperative hemorrhage and should be carefully monitored for headache and vision changes in the days after surgery.

show abstract

Section: Discussionmentioning

confidence: 68%

Risk Factors for Significant Postoperative Hemorrhage After Pituitary Neuroendocrine Tumor Resection: A Case-Control Study of 1066 Surgeries

et al. 2023

View full text Add to dashboard Cite

show abstract

“…Pituitary apoplexy is a rare but potentially life-threatening clinical syndrome caused by the sudden enlargement of a pre-existing pituitary adenoma secondary to hemorrhage, hemorrhagic infarction or infarction 2 , 6 , 9) . The pathophysiology of pituitary apoplexy is not precisely known, but many precipitating factors have been implicated, including head trauma, hypotension, a history of irradiation, cardiac surgery, pituitary dynamic testing, and anticoagulant therapy 14) .…”

Section: Discussionmentioning

confidence: 99%

Pituitary Apoplexy Following Mitral Valvuloplasty

Kim

Lee

Son

et al. 2015

J Korean Neurosurg Soc

View full text Add to dashboard Cite

Pituitary apoplexy is a rare but potentially life-threatening clinical syndrome caused by the sudden enlargement of a pituitary adenoma secondary to hemorrhage or infarction. Pituitary apoplexy after cardiac surgery is a very rare perioperative complication. Factors associated with open heart surgery that may lead to pituitary apoplexy include hemodynamic instability during cardiopulmonary bypass and systemic heparinization. We report a case of pituitary apoplexy after mitral valvuloplasty with cardiopulmonary bypass. After early pituitary tumor resection and hormonal replacement therapy, the patient made a full recovery.

show abstract

“…31 It is a rare and lifethreatening condition characterized by massive tumor swelling, intratumoral infarction, and hemorrhage that may lead to malignant cerebral edema, further mass effect, and herniation syndrome. 32 The incidence of postoperative pituitary apoplexy is noted to be between 5.4% and 12.9%. [33][34][35] Through the risk of postoperative pituitary apoplexy, incomplete resection of GPAs may independently worsen the risk profile associated with endoscopic transsphenoidal approaches and contribute to the need for early reoperation.…”

Section: Prevention Of Postoperative Pituitary Apoplexymentioning

confidence: 99%

Surgical Strategies in the Treatment of Giant Pituitary Adenomas

Joshi,

Kolb,

Khalili

et al. 2023

Operative Neurosurgery

View full text Add to dashboard Cite

BACKGROUND AND OBJECTIVES: The management of giant pituitary adenomas (GPAs) is challenging due to associated endocrinopathies and the close proximity of these tumors to critical structures, such as the optic nerves, structures of the cavernous sinus, and hypothalamus. The objective of this review article was to summarize the current management strategies for giant pituitary adenomas, including the role of open and endoscopic surgical approaches and the role of medical and radiation therapy in conjunction with surgery. METHODS: We conducted a retrospective review of GPAs operated at our institute between January 2010 and March 2023. Surgical approaches, extent of resection, and associated complications were documented. Furthermore, we conducted a thorough literature review to identify relevant studies published in the past decade, which were incorporated along with insights gained from our institutional case series of GPAs to analyze and integrate both the existing knowledge base and our institution's firsthand experience in the management of GPAs. RESULTS: A total of 46 giant pituitary adenomas (GPAs) were operated on, using various surgical approaches. Transsphenoidal approach was used in 25 cases and a staged approach using transsphenoidal and pterional was used in 15 cases. Other approaches included transcortical-transventricular, transcallosal, pterional/orbitozygomatic, and subfrontal approaches. Complications and technical nuances were reported. CONCLUSION: The management of giant pituitary adenomas remains complex, often involving several modalities—open or endoscopic resection, radiosurgery, and medical management of both the tumor and associated endocrinopathies. Surgical resections are often challenging procedures that require careful consideration of several factors, including patient characteristics, tumor location, and size, and the experience and skill of the surgical team.

show abstract

Fatal postoperative 'pituitary apoplexy': its cause and management

Cited by 56 publications

References 0 publications

Risk Factors for Significant Postoperative Hemorrhage After Pituitary Neuroendocrine Tumor Resection: A Case-Control Study of 1066 Surgeries

Risk Factors for Significant Postoperative Hemorrhage After Pituitary Neuroendocrine Tumor Resection: A Case-Control Study of 1066 Surgeries

Pituitary Apoplexy Following Mitral Valvuloplasty

Surgical Strategies in the Treatment of Giant Pituitary Adenomas

Contact Info

Product

Resources

About