Pediatric ischemic stroke from an apoplectic prolactinoma

Kasl, Rebecca A.; Hughes, Joshua D.; Burrows, Anthony M.; Meyer, Fredric B.

doi:10.1007/s00381-015-2712-8

Cited by 15 publications

(16 citation statements)

References 24 publications

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“…This is one of the few reports of an acute ischemic stroke occurring secondary to a large pituitary adenoma in a child. Pituitary tumors causing ischemic strokes in a large vascular territory are very rare [5][6][7][8][9], and the majority of reported cases have occurred in the setting of apoplexy. In a recent literature review, Banerjee et al reported a total of 25 cases of cerebral infarction from pituitary apoplexy.…”

Section: Discussionmentioning

confidence: 99%

A middle cerebral artery ischemic stroke occurring in a child with a large prolactinoma

Amara

Gupta

et al. 2019

Childs Nerv Syst

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Section: Discussionmentioning

confidence: 99%

A middle cerebral artery ischemic stroke occurring in a child with a large prolactinoma

Amara

Gupta

et al. 2019

Childs Nerv Syst

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“…3) To the best of our knowledge, only 2 previous pediatric cases of cerebral infarction associated with pituitary tumor apoplexy have been published. 3,4) Herein, we report a rare presentation of ischemic stroke due to apoplexy of pituitary macroadenoma in an adolescent male. The patient provided informed written consent for publishing the case report.…”

Section: Pituitary Apoplexy In An Adolescent Male With Macroprolactin...mentioning

confidence: 95%

Pituitary apoplexy in an adolescent male with macroprolactinoma presenting as middle cerebral artery territory infarction

Agrawal

Newbold

Busaidi³

et al. 2022

Ann Pediatr Endocrinol Metab

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Pituitary apoplexy typically presents with acute headache, vomiting, visual disturbance, and confusion. Herein, we report a rare presentation of ischemic stroke due to pituitary apoplexy. A 16.5-year-old male presented with reduced Glasgow Coma Scale (GCS) score, slurred speech, right-sided hemiparesis, and bitemporal hemianopia. Magnetic resonance imaging of the brain showed a large hemorrhagic sellar/suprasellar mass and an area of cortical T2/FLAIR hyperintensity with corresponding diffusion restriction in the middle cerebral artery territory. Computed tomography (CT) intracranial angiogram showed luminal occlusion of the clinoid and ophthalmic segments of both internal carotid arteries (ICAs, left>right) due to mass pressure effect. Biochemical investigations confirmed hyperprolactinemia and multiple pituitary hormone deficiencies. Stress-dose hydrocortisone was commenced with cabergoline, followed by urgent endoscopic transsphenoidal debulking of the tumor (subsequent histology showing prolactinoma). Postoperative CT angiogram showed improved caliber of ICAs. Intensive neurorehabilitation was implemented and resulted in complete recovery of motor and cognitive deficits. At the last assessment (18.8 years), the patient remained on complete anterior pituitary hormone replacement without cabergoline. Pituitary apoplexy is a medical emergency requiring prompt recognition and treatment and should be suspected in patients presenting with sudden, severe headache; nausea; or visual disturbance and meningism. Ischemic stroke is a rare manifestation of pituitary apoplexy in the pediatric population.

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“…3,9,14,16,17 Although the vast majority of apoplexy cases concerns adults, there are also a few reports in the pediatric population. 18,19 In gestation, maternal PA can appear at any time [20][21][22] but usually happens perinatally. 23,24 Purpose PA is a rare and potentially life-threatening condition with a highly variable clinical presentation 25,26 that is typically abrupt and impressive.…”

Section: Introduction Definitionmentioning

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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Pediatric ischemic stroke from an apoplectic prolactinoma

Cited by 15 publications

References 24 publications

A middle cerebral artery ischemic stroke occurring in a child with a large prolactinoma

A middle cerebral artery ischemic stroke occurring in a child with a large prolactinoma

Pituitary apoplexy in an adolescent male with macroprolactinoma presenting as middle cerebral artery territory infarction

Presenting Symptoms of Pituitary Apoplexy

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