New oral anticoagulants and pituitary apoplexy

Doglietto, Francesco; Costi, Emanuele; Villaret, Andrea Bolzoni; Mardighian, Dikran; Fontanella, Marco Maria; Giustina, Andrea

doi:10.1007/s11102-014-0616-3

Cited by 19 publications

(14 citation statements)

References 5 publications

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“…In addition, it is suggested that pituitary gland might have a critical perfusion pressure well below normal arterial pressure (24). It is possible that this peculiar vascularity and sudden alterations in perfusion pressure by various triggering factors (Table 1) (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37), may predispose to sudden hemorrhage and/or infarction in micro adenomas as well as non-adenomatous lesions. Diabetes and arterial hypertension do not predispose patients to PA as reported in previous studies (16).…”

Section: Pathophysiologymentioning

confidence: 99%

Clinical and imaging features of pituitary apoplexy and role of imaging in differentiation of clinical mimics

Goyal¹,

Utz²,

Gupta³

et al. 2018

Quant. Imaging Med. Surg.

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To discuss the clinical syndrome, review common imaging findings of pituitary apoplexy (PA) and role of imaging in therapy and follow-up. Also, to review other acute clinical scenarios with similar clinical and/or imaging findings as PA. PA is a severe and potentially life-threatening medical emergency, characterized by constellation of symptoms/signs that occur as a result of acute hemorrhage and/or infarction in pituitary gland. Patients present with acute and sudden onset of symptoms/signs, most commonly with severe headache, vision deficits/ophthalmoplegia, altered mental status, and possible pan hypopituitarism. Pre-existing macro adenoma (65-90%), especially non-functioning and prolactinomas, are most susceptible to apoplexy, which undergoes hemorrhage or infarct, but PA can occur with normal pituitary or microadenoma. Because of the probable grave prognosis of PA, imaging characteristics of PA and other acute clinical scenarios with similar clinical and/or imaging findings should be familiar to radiologists. PA is potentially a life-threatening clinical syndrome, however, imaging and clinical findings can lead the radiologist towards appropriate diagnosis, and rule out other clinical mimics. When hemorrhage is secondary to an underlying lesion, regrowth of the pituitary tumor years after a PA episode is possible and patients require long-term clinical and imaging surveillance.

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Section: Pathophysiologymentioning

confidence: 99%

Clinical and imaging features of pituitary apoplexy and role of imaging in differentiation of clinical mimics

Goyal¹,

Utz²,

Gupta³

et al. 2018

Quant. Imaging Med. Surg.

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“…New oral anticoagulants may also be involved [19, 20]. A precipitating role has been attributed also to the use of dopamine agonists (either at the beginning or after discontinuation of therapy) [21–28] and to oestrogen administration [29].…”

Section: Pathophysiologymentioning

confidence: 99%

Multidisciplinary Management of Pituitary Apoplexy

Albani

Ferraú

Angileri

et al. 2016

International Journal of Endocrinology

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Pituitary apoplexy is a rare clinical syndrome due to ischemic or haemorrhagic necrosis of the pituitary gland which complicates 2–12% of pituitary tumours, especially nonfunctioning adenomas. In many cases, it results in severe neurological, ophthalmological, and endocrinological consequences and may require prompt surgical decompression. Pituitary apoplexy represents a rare medical emergency that necessitates a multidisciplinary approach. Modalities of treatment and times of intervention are still largely debated. Therefore, the management of patients with pituitary apoplexy is often empirically individualized and clinical outcome is inevitably related to the multidisciplinary team's skills and experience. This review aims to highlight the importance of a multidisciplinary approach in the management of pituitary apoplexy and to discuss modalities of presentation, treatment, and times of intervention.

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“…PA has been observed after administration of anticoagulant drugs (vitamin K antagonist or platelet inhibitors) or thrombolytic agents, sometimes very soon after the initiation of treatment or after a prolonged period of treatment [6,9,47]. New classes of anticoagulant (dabigatran) [48,49] may also be involved.…”

Section: Anticoagulated Statesmentioning

confidence: 99%

Pituitary Apoplexy

Jemel¹,

Alaya²,

Boubaker³

et al. 2019

Pituitary Diseases

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Pituitary apoplexy is a rare clinical emergency due to acute ischemic infarction or hemorrhage of the pituitary gland. As this disorder most often involves a pituitary adenoma, especially nonfunctioning tumors, the syndrome should be referred to as pituitary tumor apoplexy. The precise physiopathology is not completely clear. Although in most cases it occurs spontaneously, pituitary apoplexy can be precipitated by many risk factors. The main symptom is headache of sudden onset associated with visual disturbances, signs of meningeal irritation, and/or endocrine dysfunction. Corticotropic deficiency is a potentially life-threatening disorder. Magnetic resonance imaging is the most sensitive to confirm the diagnosis by revealing a pituitary tumor with hemorrhagic and/or necrotic components. Earlier studies used to consider urgent decompression of the lesion surgically, but nowadays, more recent studies favor conservative management in selected patients (those without important visual acuity or field defects and with normal consciousness). This wait-and-see approach gives evidence of excellent outcomes in terms of oculomotor palsy, pituitary function, and subsequent tumor growth. Surgical decompression may be necessary in some cases. Once the acute phase is over, the patient should be reevaluated for hormonal deficiencies. Moreover, spontaneous remission of syndromes, such as acromegaly, may be caused by pituitary adenoma apoplexy.

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New oral anticoagulants and pituitary apoplexy

Cited by 19 publications

References 5 publications

Clinical and imaging features of pituitary apoplexy and role of imaging in differentiation of clinical mimics

Clinical and imaging features of pituitary apoplexy and role of imaging in differentiation of clinical mimics

Multidisciplinary Management of Pituitary Apoplexy

Pituitary Apoplexy

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