Headaches in Patients with Pituitary Tumors: a Clinical Conundrum

Donovan, Laura; Welch, Mary

doi:10.1007/s11916-018-0709-1

Cited by 17 publications

(13 citation statements)

References 48 publications

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“…Rehman L. also reported headache and visual disturbance to be present in 87.3% and 88.8% of patients respectively, in his study. [23][24][25][26]. Visual field defects associated with pituitary adenoma ranges from 37-96%.…”

Section: Discussionmentioning

confidence: 99%

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Frequency of Pituitary Adenoma among the Patients with Chronic Headache

Jatoi

et al. 2021

JPRI

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Background: Antero-superior, Pituitary Gland lies in vicinity of optic chiasm and antero-inferiorly, it is related with posterior wall of sphenoid bone. Pituitary Gland is consisting of three lobes: Anterior, intermediate and posterior and their secretion are regulated by hypothalamus. Aims and Objectives: To identify pituitary adenoma in the patients coming with complain of chronic headache. Materials and Methods: Seven hundred sixty-four patients were included in our study. All the patients with chronic headache with/without decreased vision and visual field defects were included our study. Those patients already diagnosed with any other cause of headache such as uncontrolled blood pressure, tumor or diagnosed case of pituitary adenoma and patient with glaucoma were excluded. Detailed history was taken and ocular examination was done. MRI orbit and brain with contrast was done in all patients. Results: Out of 764 patients, 32 patients were diagnosed as having pituitary adenoma. Macro-adenoma was present in 30 patients and micro-adenoma in 2 patients. On MRI majority of patients had optic chiasm compression with bi-temporal hemianopia. Conclusion: All the patients with chronic headache with/without visual disturbances and visual field defect must be properly examined and investigated as that will help other researchers to diagnose the Pituitary Adenomas.

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Section: Discussionmentioning

confidence: 99%

“…Posterior pituitary gland (PPG) stores and secretes Antidiuretic hormone (ADH) and oxytocin, which are formed in hypothalamus. [7,8] Pituitary Adenomas (PAs) are compendium of tumors arising from APG and it accounts for 10-25 % of tumors, out of all intracranial tumors [9,10]. Prevalence of pituitary adenoma is 17% worldwide.…”

Section: Introductionmentioning

confidence: 99%

Frequency of Pituitary Adenoma among the Patients with Chronic Headache

Jatoi

et al. 2021

JPRI

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“…Yet, given the conflicting data, it is evident that the relationship between pituitary tumors and headaches remains unclear, and headaches alone are a rare indication for surgical management. 17 Since headaches linked to pituitary adenomas can mimic primary headache disorders, particularly the trigeminal autonomic cephalalgias, it is important to maintain a high index of clinical suspicion for a secondary process in a patient with refractory headaches. 3,15 If imaging fails to reveal an abnormality, there is benefit in a hormone panel and medical management with alternative pharmacotherapy than usually prescribed for headache.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple mechanisms have been proposed for pituitary adenomas causing CH-like attacks, including tumor invasion into adjacent areas, 3, 7 –9,15–17 mass effect/tumor size, 3,7,10,11,15,16 hormonal secretion, 3,15 –17 and inflammation or irritation of pain-sensitive structures, such as the meninges. 3,16,17 In our case and one other, 12 CH-like attacks were initially associated with normal imaging that later revealed a macroadenoma. Unlike our case, the other report was of a single type of headache with typical features of CH.…”

Section: Discussionmentioning

confidence: 99%

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A triad of cluster-like headaches with delayed development of a macroscopic prolactinoma: A case report

Ihezie

Chandalia

Burish

2020

Cephalalgia Reports

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Pituitary hormone testing is recommended in refractory cluster headache (CH), but supporting evidence is limited. We present a patient with cluster-like headaches and a negative brain magnetic resonance imaging (MRI) 1 year after headache onset. He failed multiple medication trials. Three years after headache onset, additional workup showed abnormal pituitary labs including hyperprolactinemia and a brain MRI with a 15 × 15 × 14 mm3 enhancing pituitary lesion. With cabergoline 0.25 mg twice weekly, the patient has been headache-free for over 2 years. This case supports the recommendations for pituitary testing in refractory CH, even if imaging is initially negative for a pituitary tumor.

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Opioid use after endoscopic skull base surgery: A descriptive, prospective, longitudinal cohort study

Rimmer

Scott

Pailet

et al. 2021

Int Forum Allergy Rhinol

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Background Opioid abuse is a public health crisis and the perioperative period can be a time of first opioid exposure. Little is known about postoperative pain management after endoscopic skull base surgery (ESBS). Methods This investigation was a single‐institution, longitudinal, prospective cohort study of adult patients undergoing ESBS between November 2019 and March 2020. Participants completed preoperative questionnaires and were contacted every 48 hours postoperatively to quantify pain and opioid consumption. Results A total of 33 patients were enrolled and 28 of 33 patients (85%) underwent ESBS for sellar pathology. Mean total morphine milligram equivalents (MME) consumed was 381.9 ± 476.0. History of a headache disorder (p = 0.025) and previous opioid use within 60 days preoperatively (p < 0.001) were significantly associated with greater opioid use. Mean duration of opioid use was 6.7 ± 5.1 (range, 0‐20) days. Headache disorder (p = 0.01), depression (p = 0.03), anxiety (p = 0.03), age ≤46 years (p = 0.029), and previous opioid use (p = 0.008) were all associated with longer mean opioid use. Patients with headache disorder also reported higher mean postoperative pain scores. Fewer than half of the participants required opioids by postoperative day 8. Prescription of nonsteroidal anti‐inflammatory drugs at discharge was significantly associated with less outpatient opioid use (p = 0.032). At 2‐month follow‐up, 37% of patients reported keeping excess opioids. Conclusion After ESBS, greater total opioid use was significantly associated with history of headaches and previous opioid use within 60 days. Overall, opioid use declined among all patients in the postoperative period, but several factors may contribute to longer duration of use.

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Headaches in Patients with Pituitary Tumors: a Clinical Conundrum

Cited by 17 publications

References 48 publications

Frequency of Pituitary Adenoma among the Patients with Chronic Headache

Frequency of Pituitary Adenoma among the Patients with Chronic Headache

A triad of cluster-like headaches with delayed development of a macroscopic prolactinoma: A case report

Opioid use after endoscopic skull base surgery: A descriptive, prospective, longitudinal cohort study

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