Giant necrotic pituitary apoplexy

Fanous, Andrew A.; Quigley, Edward P.; Chin, Steven S.; Couldwell, William T.

doi:10.1016/j.jocn.2012.07.023

Cited by 8 publications

(12 citation statements)

References 5 publications

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“…1,37,39,[49][50][51] Pituitary dysfunction may be explained by compression of the pituitary gland from the apoplectic adenoma, vascular compromise from apoplexy, and surgical manipulation. 52,53 All patients presented who exhibited hypopituitarism were treated with replacement therapy with excellent results in the follow-up period (with a mean of 26 months).…”

Section: Surgical Complicationsmentioning

confidence: 99%

Endoscopic Endonasal Transsphenoidal Approach for Apoplectic Pituitary Tumor: Surgical Outcomes and Complications in 45 Patients

Zhan

2015

J Neurol Surg B

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Objective To assess the safety and effectiveness of the endoscopic endonasal transsphenoidal approach (EETA) for apoplectic pituitary adenoma. Design A retrospective study. Setting Qilu Hospital of Shandong University; Brain Science Research Institute, Shandong University. Participants Patients admitted to Qilu Hospital of Shandong University who were diagnosed with an apoplectic pituitary tumor and underwent EETA for resection of the tumor. Main Outcome Measures In total 45 patients were included in a retrospective chart review. Data regarding patient age, sex, presentation, lesion size, surgical procedure, extent of resection, clinical outcome, and surgical complications were obtained from the chart review. Results In total, 38 (92.7%) of 41 patients with loss of vision obtained visual remission postoperatively. In addition, 16 patients reported a secreting adenoma, and postsurgical hormonal levels were normal or decreased in 14 patients. All other symptoms, such as headache and alteration of mental status, recovered rapidly after surgery. Two patients (4.4%) incurred cerebrospinal fluid leakage. Six patients (13.3%) experienced transient diabetes insipidus (DI) postoperatively, but none of these patients developed permanent DI. Five patients (11.1%) developed hypopituitarism and were treated with replacement of hormonal medicine. No cases of meningitis, carotid artery injury, or death related to surgery were reported. Conclusion EETA offers a safe and effective surgical option for apoplectic pituitary tumors and is associated with low morbidity and mortality.

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Section: Surgical Complicationsmentioning

confidence: 99%

Endoscopic Endonasal Transsphenoidal Approach for Apoplectic Pituitary Tumor: Surgical Outcomes and Complications in 45 Patients

Zhan

2015

J Neurol Surg B

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“…Review of the literature revealed other precipitating factors in adult patients, such as surgery in two cases described by Goel et al [ 12 ] and in four cases reported by Ahmad et al [ 16 ], endocrine stimulation tests in one case [ 9 ], and post-partum in one case [ 13 ]. Fanous et al and Romano et al published two cases of spontaneous PA [ 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…It should be highlighted that PA as an exclusively presenting symptom is very uncommon in the literature published to date (reviewed in Table 1 ). Indeed, the presence of a giant pituitary adenoma was not known prior to the clinical manifestation of PA in the cases reported by Perotti et al, Fanous et al, and Romano et al [ 13 , 14 , 15 ]. In contrast, PA occurred in a previously known pituitary tumour in the other published case reports and case series [ 11 , 12 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…In this context, the literature review points towards a favourable long-term follow-up in the two cases reported by Perotti et al [ 11 ] and Fanous et al [ 12 ], with a near complete-to-complete clinical resolution of post-partum PA and spontaneous PA treated with steroids and radical surgery, respectively. Conversely, Goel et al [ 10 ] and Ahmad et al [ 14 ] described a series of cases who underwent re-surgery of a known residual pituitary tumour complicated by PA, with unfavourable outcomes (exitus). This variability in the patients’ outcome highlights the need for a prompt medical therapy and, when possible, a radical tumour resection.…”

Section: Discussionmentioning

confidence: 99%

“…Here, we describe the case of a giant NFPA complicated by PA. In this context, there are very few literature reports of giant NFPAs presenting solely with PA. A PubMed-based literature review found that only five case reports [ 11 , 12 , 13 , 14 , 15 ] and a case series of four adult patients [ 16 ] had been published from 1990 to November 2021. The other reports of PA were in functioning pituitary macroadenomas and were therefore excluded; also excluded were cases reporting PA in pituitary adenomas where the tumour size was not specified.…”

Section: Introductionmentioning

confidence: 99%

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Neurological Presentation of Giant Pituitary Tumour Apoplexy: Case Report and Literature Review of a Rare but Life-Threatening Condition

Puglisi

Morini

Biasini

et al. 2022

JCM

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Background: Giant pituitary adenomas are benign intracranial tumours with a diameter ≥4 cm. Even if hormonally non-functional, they may still cause local extension, leading to symptoms that include mostly gland dysfunction, mass effects, and, much less frequently, apoplexy due to haemorrhage or infarction. Neurological presentation of giant pituitary tumour apoplexy is even more rare and has not been systematically reviewed. Case Presentation: An 81-year-old woman was admitted to the Emergency Department because of acute onset headache, bilateral visual deficit, and altered consciousness. Computed tomography showed a giant mass lesion (>5.5 cm diameter) expanding upward to the suprasellar cistern, optic chiasm, and third ventricle, over-running the sphenoid sinus, and with lateral invasion of the cavernous sinus. Laboratory investigations revealed central adrenal and hypothyroidism insufficiency, while magnetic resonance imaging confirmed a voluminous suprasellar tumour (~6 cm diameter), with signs of pituitary tumour apoplexy. Neurological manifestations and gland-related deficits improved after hormonal replacement therapy with a high dose of intravenous hydrocortisone, followed by oral hydrocortisone and levo-thyroxine. The patient declined surgical treatment and follow-up visit. Conclusions: Giant pituitary tumour apoplexy is a rare but potentially life-threatening condition. Prompt diagnosis and multidisciplinary management may allow a remarkable clinical improvement, as seen in this case.

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Pituitary Apoplexy

2016

Diagnostic Imaging: Brain

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Giant necrotic pituitary apoplexy

Cited by 8 publications

References 5 publications

Endoscopic Endonasal Transsphenoidal Approach for Apoplectic Pituitary Tumor: Surgical Outcomes and Complications in 45 Patients

Endoscopic Endonasal Transsphenoidal Approach for Apoplectic Pituitary Tumor: Surgical Outcomes and Complications in 45 Patients

Neurological Presentation of Giant Pituitary Tumour Apoplexy: Case Report and Literature Review of a Rare but Life-Threatening Condition

Pituitary Apoplexy

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