Pituitary apoplexy: do histological features influence the clinical presentation and outcome?

Semple, Patrick; Villiers, J. C. De; Bowen, Robert M.; Lopes, M. Beatriz S.; Laws, Edward R.

doi:10.3171/jns.2006.104.6.931

Cited by 66 publications

(52 citation statements)

References 20 publications

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“…Instead, MRI was extremely sensitive for the detection of hemorrhage into the pituitary mass; the rate of MRI-detected hemorrhage in our study (89%) is comparable to that reported for other smaller modern series. 20,29,31,33 MRI can also be used to assess the tissue surrounding the pituitary mass and hence may alter the eventual management of the patients. In our study, optic chiasm compression was seen in 62.2% and extension of the tumor into the cavernous sinus was seen in 41.5% patients.…”

Section: Discussionmentioning

confidence: 99%

“…Very few series have included more than 50 patients and presented a long-term followup. 33 In this study, we retrospectively analyzed the clinical presentation, predisposing factors, therapeutic management, and clinical recovery of a large series of pituitary apoplexy patients treated at our institutions over a period of 22 years, with an emphasis on the long-term visual, endocrine, and functional outcomes.…”

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confidence: 99%

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Management and outcomes of pituitary apoplexy

Singh¹,

Valizadeh²,

Meyer³

et al. 2015

JNS

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OBJECT This study was undertaken to analyze the predisposing factors, clinical presentation, therapeutic management, and clinical recovery in patients with pituitary apoplexy, with an emphasis on the long-term visual, endocrine, and functional outcomes. METHODS The authors performed a retrospective analysis of consecutive cases involving patients treated at Mayo Clinic between 1992 and 2013. Patients were included in the study only if they had 1) abrupt onset of severe headache or visual disturbance in the presence of a pituitary adenoma and 2) radiological or surgical confirmation of a pituitary mass. The primary endpoints of analysis were the visual (ocular motility, visual fields, and visual acuity), endocrine, and functional outcomes (using the modified Rankin Scale). RESULTS Eighty-seven patients were identified (57 males and 30 females, mean age 50.9 years, range 15–91 years). Twenty-two patients (25.3%) had a known pituitary adenoma. Hypertension was the most common associated factor (39%). Headache was the most frequent presenting symptom (89.7%), followed by visual abnormalities (47.1%). Cranial nerve palsies were present in 39% and visual field defects in 34.1%. MRI detected hemorrhage in 89% patients, as compared with 42% detected by CT scan. Sixty-one patients (70.1%) underwent surgery during acute hospitalization (median time from apoplexy 5 days, IQR 3–10 days), 8 (9.2%) had delayed surgery, and 18 (20.7%) were treated conservatively. Histopathological examination revealed adenoma with pure necrosis in 18 (30%), pure hemorrhage in 4 (6.7%), and both in 6 (10%) patients. Four patients died during hospitalization. The average duration of follow-up was 44.2 ± 43.8 months. All survivors were independent and had complete resolution or substantial improvement in eye movements and visual fields at the last follow-up. Many patients needed long-term hormonal replacement with levothyroxine (62.7%) and cortisol (60%). Daily desmopressin was needed in 23% of all surgical patients at 3 months (versus none of the medically treated) and this requirement decreased slightly over time. Regrowth of pituitary adenoma was seen in 7 patients (8.6%). There were no statistically significant differences in any of the outcome measures across the treatment groups. CONCLUSIONS The outcome of most patients with pituitary apoplexy is excellent. Selected patients can be managed conservatively, and patients with severe neuro-ophthalmological deficits treated with early surgery can achieve an excellent recovery.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Management and outcomes of pituitary apoplexy

Singh¹,

Valizadeh²,

Meyer³

et al. 2015

JNS

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“…Alternatively, kinking or pressure on the infundibulum by edematous, hemorrhagic material, which impeded transit of antidiuretic hormone from the preoptic and paraventricular nuclei of the hypothalamus to the posterior lobe, might prove to be the originating cause of diabetes insipidus 21 . The possible pathophysiology involved in this case is the pressure on the infundibulum by edematous or hemorrhagic material, which makes the diabetes insipidus transitory more probable.…”

Section: Discussionmentioning

confidence: 99%

Transient central diabetes insipidus followed by pituitary apoplexy treated in a conservative way

Silva

Lima

Machado

et al. 2008

Arq. Neuro-Psiquiatr.

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apoplexia hipofisária com TraTamenTo conservador seguido por diabeTes insipidus cenTral TransiTório 2,3 . These findings are often accompanied by various degrees of hypopituitarism, even without surgical management of the apoplexy. Even though, posterior pituitary function is nearly always preserved, a few cases of diabetes insipidus have been described 5,6 . Diabetes insipidus occurs transiently in about 4% of patients with apoplexy and persistently in only 2 % of these patients [5][6][7] . We report a patient with a previously non diagnosed nonfunctioning pituitary tumor that developed central diabetes insipidus following pituitary apoplexy. caseA 49-year-old man, previously diagnosed with systemic arterial hypertension, presented to emergence room with severe headache. On physical examination blood pressure was 160x100 mm Hg. After 10 hours, despite of blood pressure normalization, the headache persisted and was followed by ophthalmoplegia, meningeal irritation signs and consciousness impairment. A lumbar puncture was performed and meningitis was excluded. Brain computed tomography was done and only maxillary sinusitis was detected. Three days after, the patient developed hypotension. Magnetic resonance imaging demonstrated a macroadenoma of 20x15x15 mm with supra-sellar extension and intratumoral hemorrhage (Figure). At that moment, pituitary function tests were normal (thyrotropin: 1.46 mcUI/mL; RV: 0.3 a 5.0 mcUI/mL; free T4: 1.3 ng/dL; RV: 0.8-1.9 ng/dL; prolactin: 3.4 ng/dL; RV: 2,0 a 15,2 ng/mL) except for a low cortisol level (5.7 Figure. MRI (T1 weighed, coronal) showing a macroadenoma with supra-sellar extension and intratumoral hemorrhage, before gadolinium injection (A) and after gadolinium injection (B).

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“…3,23) Acute tumor enlargement caused by intratumoral hemorrhage and compression of the surrounding tissues is important in causing these symptoms. The present case is unique because massive ICH resulting from pituitary apoplexy caused severe conscious disturbance.…”

Section: Discussionmentioning

confidence: 99%

Pituitary Apoplexy Manifesting as Massive Intracerebral Hemorrhage

Kurisu

Kawabori

Niiya

et al. 2012

Neurol. Med. Chir.(Tokyo)

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A 68-year-old man presented with severe conscious disturbance caused by pituitary apoplexy resulting in massive intracerebral hemorrhage (ICH). He had been periodically followed up for asymptomatic pituitary adenoma at another hospital for 8 years. Neuroimaging examination revealed pituitary apoplexy and massive ICH located in the left frontal lobe, and the ICH was directly connected to the intratumoral hemorrhage. The diagnosis was massive ICH from pituitary apoplexy. The patient underwent emergent evacuation of hematoma and removal of the pituitary adenoma via bi-frontal craniotomy. Postoperatively, he continued to exhibit deep consciousness disturbance and died 1 month after the operation. Pituitary apoplexy is usually characterized by intra-tumoral hemorrhage. The treatment strategy for asymptomatic pituitary adenoma is still controversial. This case shows that we should always consider the risk of pituitary apoplexy manifesting as ICH which may cause a fatal outcome.

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Pituitary apoplexy: do histological features influence the clinical presentation and outcome?

Cited by 66 publications

References 20 publications

Management and outcomes of pituitary apoplexy

Management and outcomes of pituitary apoplexy

Transient central diabetes insipidus followed by pituitary apoplexy treated in a conservative way

Pituitary Apoplexy Manifesting as Massive Intracerebral Hemorrhage

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