Incidence of headache as a presenting complaint in over 1000 patients with sellar lesions and factors predicting postoperative improvement

Jahangiri, Arman; Wagner, Jeffrey; Chin, Aaron; Han, Sung Won; Tran, Mai; Miller, Liane M.; Tom, Maxwell W.; Chen, Rebecca; Kunwar, Sandeep; Blevins, Lewis S.; Aghi, Manish K.

doi:10.1016/j.clineuro.2015.02.006

Cited by 28 publications

(24 citation statements)

References 29 publications

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“…Our study shows that headache and depression is commonly observed in patients with HPD. This is consistent with previous findings that more than a third of all HPD patients suffer from headache [3,10]. Jahangiri et al analyzed over 1 000 consecutive patients undergoing transsphenoidal surgery and found younger patients, females, and patients with RCCs and apoplexy more likely to present with headache [10].…”

supporting

confidence: 90%

Headache and Depression in Patients with Hypothalamic-pituitary Disorders-etiology and Risk Factors

Harbeck

Haas

Suefke

et al. 2015

Exp Clin Endocrinol Diabetes

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supporting

confidence: 90%

Headache and Depression in Patients with Hypothalamic-pituitary Disorders-etiology and Risk Factors

Harbeck

Haas

Suefke

et al. 2015

Exp Clin Endocrinol Diabetes

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“…24 A recent retrospective study found that 24% of patients with pituitary tumours had headache as their chief complaint before surgery. 25 In the present study 12% of our patients had headache as the main symptom leading to the diagnostic MRI, presumably contributing to the higher prevalence of headache than in the general population at diagnose. The availability of MRI is exceptionally high in Norway and the number of benign extra-axial brain tumors due to incidental findings are therefore rising.…”

mentioning

confidence: 86%

“…8 A recent retrospective review of 1015 patients with sellar lesions (66% adenomas) found that patients with gross total resection (GTR) more often achieved postoperative headache improvement, in line with the hypothesis that the underlying cause of headache is mass effect. 25 However, another recent study found that headaches were equally frequent in patients with microadenomas and macroadenomas. 29 In our study, neither residual tumor nor tumor size was associated with headache.…”

mentioning

confidence: 99%

Pituitary Adenoma and Non-acute Headache: Is There an Association, and Does Treatment Help?

et al. 2016

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This work is based on a master thesis in applied clinical science at The Department of Public Health and General Practice, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway. The content is concealed until 2018. Sources of financial and material support:The expenses were covered by the Norwegian Advisory Unit on Headache Gravdahl Abstract:Objective: Headache is a controversial indication for treatment of pituitary adenoma. We sought to study the possible relationship between pituitary adenomas and headache along with the symptomatic effects of treatment.Methods: 201 patients with pituitary adenoma underwent structured telephone interviews addressing current and prior headache complaints. Clinical variables and headache history were retrieved from medical records. Headache prevalence among patients was compared to a regional population-based cohort.Results: Headache suffering prior to the pituitary adenoma diagnosis was higher than in the general population (p<0.001). At follow-up, overall prevalence was lower (p<0.001), but chronic headache was more prevalent (p= 0.001) than in the general population. With the exception of family history, no associations between headache and clinical or radiological variables were identified. 77% of headache sufferers reported improvement and5 % reported worsening while 11 % reported new headaches at follow-up. Operated patients with non-functional adenoma more often reported improvement (85%) than non-operated patients (58%) (p=0.042). Conclusion:In a cohort with both treated and untreated patients with pituitary adenoma headache prevalence is low compared to the general population. We found no link between clinical or radiological variables and headache. Even though a higher proportion of operated patients report symptomatic relief, the majority of non-treated patients also improved. We believe that the rather unpredictable dynamics of headache over time and the lack of predictive and modifiable tumor related variables associated with headache or relief we believe this weakens headache as a sole indication for pituitary adenoma treatment.

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“…The latter can lead to blunting of consciousness via hyponatremia, myxedema, and/or hyperglycemia. 21,22,30,70,71,87,88 Sudden-onset severe headache ("thunderclap" headache) is the most common presenting symptom of PA (95-100%), 1,3,10,12,14,16,19,20,36,45,46,59,64,[67][68][69]71,73,75,[79][80][81][82][83][84][85]89,90 followed by nausea (80%), visual deficits (71-82%), 3,85 and vomiting (69%). 16 Headache is the usual cause for hospital referral.…”

Section: Causes and Risk Factorsmentioning

confidence: 99%

“…16 Headache is the usual cause for hospital referral. 14,79,90 The location of pain may be retrobulbar 14,30,91 or frontal. 30 Nausea and vomiting can be the result of headache, meningeal irritation, hypothalamic dysfunction, elevated intracranial pressure, or acute adrenal insufficiency.…”

Section: Causes and Risk Factorsmentioning

confidence: 99%

Presenting Symptoms of Pituitary Apoplexy

Pyrgelis

Mavridis

Meliou

2017

J Neurol Surg A Cent Eur Neurosurg

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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.

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Incidence of headache as a presenting complaint in over 1000 patients with sellar lesions and factors predicting postoperative improvement

Cited by 28 publications

References 29 publications

Headache and Depression in Patients with Hypothalamic-pituitary Disorders-etiology and Risk Factors

Headache and Depression in Patients with Hypothalamic-pituitary Disorders-etiology and Risk Factors

Pituitary Adenoma and Non-acute Headache: Is There an Association, and Does Treatment Help?

Presenting Symptoms of Pituitary Apoplexy

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