Multiple Pituitary Apoplexy—Cavernous Sinus Invasion as Major Risk Factor for Recurrent Hemorrhage

Hosmann, Arthur; Micko, Alexander; Frischer, Josa M.; Roetzer, Thomas; Vila, Greisa; Wolfsberger, Stefan; Knosp, Engelbert

doi:10.1016/j.wneu.2019.02.138

Cited by 10 publications

(12 citation statements)

References 34 publications

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“…PA-associated visual disturbances include decreased visual acuity in most cases [ 11 , 25 , 31 , 32 , 33 , 37 , 57 , 70 , 75 , 80 , 93 , 96 , 97 , 98 , 101 , 102 , 105 , 110 , 113 , 120 , 121 , 128 , 135 , 146 , 168 , 177 , 187 , 190 , 196 ]. Complete blindness was reported in two papers [ 199 , 212 ].…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

“…One case of gigantism (+5 SD) was reported on a 9-year-old boy with lactosomatotroph PitNET [ 32 ]. Hypopituitarism included elements of hypogonadism [ 127 , 128 , 129 , 131 , 135 ] like disturbances of menstrual cycle in women of reproductive age [ 171 , 172 ], etc., but, also, with a more severe potential, hypotension [ 29 , 48 , 83 , 199 , 210 , 213 ].…”

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%

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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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“…Follow-up imaging to look for residual/recurrent tumour and radiotherapy. A further look into the molecular markers predisposing to recurrent haemorrhages to be looked in future [152][153][154][155][156][157][158][159][160].…”

Section: Recurrent Pituitary Apoplexymentioning

confidence: 99%

Pituitary Tumours

Sivakoti¹,

Anne²,

Arora³

et al. 2022

Central Nervous System Tumors

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The chapter focuses on understanding the latest classification of the pituitary adenomas in light of immuno-histological and molecular signatures as envisaged in the latest WHO classification guidelines. It further looks into evaluating and analysing the symptoms of the adenoma locally and at distant organs. Imaging and hormonal analysis has been discussed in detail for both functional, non-functional and pituitary apoplexy. Further, the therapeutic options- medical, surgical and their outcomes have been highlighted.

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“…Moreover, the predictive factors of recurrent apoplexy have not been well studied. 5,[16][17][18][19] Pituitary apoplexy is known to be associated with a higher rate of tumor recurrence postoperatively, likely because of incomplete resection. 5 Additionally, partial removal of a macroadenoma can devascularize the tumor leading to postoperative hemorrhagic infarction.…”

Section: Introductionmentioning

confidence: 99%

Predictive Clinical and Surgical Factors Associated with Recurrent Apoplexy in Pituitary Adenomas

Siu

Rangarajan

Karsy

et al. 2021

J Neurol Surg B Skull Base

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Introduction Pituitary apoplexy is an uncommon clinical condition that can require urgent surgical intervention, but the factors resulting in recurrent apoplexy remain unclear. The purpose of this study is to determine the risks of a recurrent apoplexy and better understand the goals of surgical treatment. Methods A retrospective chart review was performed for all consecutive patients diagnosed and surgically treated for pituitary apoplexy from 2004 to 2021. Univariate analysis was performed to identify risk factors associated with recurrent apoplexy. Results A total of 115 patients were diagnosed with pituitary apoplexy with 11 patients showing recurrent apoplexy. This occurred at a rate of 2.2 cases per 100 patient-years of follow-up. There were no major differences in demographic factors, such as hypertension or anticoagulation use. There were no differences in tumor locations, cavernous sinus invasion, or tumor volumes (6.84 ± 4.61 vs. 9.15 ± 8.45 cm, p = 0.5). Patients with recurrent apoplexy were less likely to present with headache (27.3%) or ophthalmoplegia (9.1%). Recurrent apoplexy was associated with prior radiation (0.0 vs. 27.3%, p = 0.0001) and prior subtotal resection (10.6 vs. 90.9%, p = 0.0001) compared with first time apoplexy. The mean time to recurrent apoplexy was 48.3 ± 76.9 months and no differences in overall follow-up were seen in this group. Conclusion Recurrent pituitary apoplexy represents a rare event with limited understanding of pathophysiology. Prior STR and radiation treatment are associated with an increased risk. The relatively long time from the first apoplectic event to a recurrence suggests long-term patient follow-up is necessary.

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Multiple Pituitary Apoplexy—Cavernous Sinus Invasion as Major Risk Factor for Recurrent Hemorrhage

Cited by 10 publications

References 34 publications

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

Pituitary Tumours

Predictive Clinical and Surgical Factors Associated with Recurrent Apoplexy in Pituitary Adenomas

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