Pituitary Apoplexy in Acromegaly

Taylor, Andrew; Finster, Joseph L.; Raskin, Philip; Field, James B.; Mintz, Daniel H.

doi:10.1210/jcem-28-12-1784

Cited by 45 publications

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“…Hormonal changes occur during acute episodes of pituitary apoplexy, as has been previously reported [15][16][17]. If this is the case, the elevated serum ACTH level may be the result of excess hormone released into the bloodstream from the pituitary adenoma upon its destruction.…”

Section: Discussionmentioning

confidence: 84%

Corticotroph Cell Adenoma without Typical Manifestations of Cushing's Disease Presenting with Cavernous Sinus Syndrome following Pituitary Apoplexy.

et al. 2001

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Abstract.This report presents a unique case of corticotroph cell adenoma in a 30-year-old man without acromegaly or features typical of Cushing's disease, who developed cavernous sinus syndrome following pituitary apoplexy. Magnetic resonance imaging revealed a large intrasellar/suprasellar mass with pituitary hemorrhage and extension of a hematoma to the anterior base of the skull. Urgent transnasal pituitary surgery revealed an acidophilic pituitary adenoma, with immunoreactivity for ACTH and GH and expression of proopiomelanocortin (POMC) and GH messenger ribonucleic acid (mRNA) demonstrated by in situ hybridization.To our knowledge, a silent corticotroph cell adenoma with GH production has never been reported.This type of adenoma may potentially enlarge and develop tumoral hemorrhage because it is free of endocrinological symptoms.

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Section: Discussionmentioning

confidence: 84%

Corticotroph Cell Adenoma without Typical Manifestations of Cushing's Disease Presenting with Cavernous Sinus Syndrome following Pituitary Apoplexy.

et al. 2001

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“…Spontaneous remission of acromegaly following apoplexy has been reported in more than 20 cases [5][6][7][8][9][10][11][12]. Most of them were reported in the pre-MRI era, were associated with hypopituitarism, and were treated conservatively.…”

Section: Discussionmentioning

confidence: 99%

“…When apoplexy arises in functioning adenomas, it may result in spontaneous remission of symptoms by reduction of hypersecreted pituitary hormones usually with hypopituitarism. Cases with remission of acromegaly have been most frequently reported [5][6][7][8][9][10][11][12], whereas prolactinoma cases with remission of amenorrhea have been rarely reported [13]. Diagnosis of apoplexy without massive hemorrhage is often difficult since no specific CT or MRI findings of infarction have been reported [1,14,15], and the indications of surgery remain controversial [1].…”

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confidence: 99%

Spontaneous Remission of Functioning Pituitary Adenomas without Hypopituitarism following Infarctive Apoplexy: Two Case Reports

2005

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Abstract. Functioning pituitary adenomas may exhibit spontaneous remission after pituitary apoplexy usually in association with hypopituitarism. We report two patients who presented with sudden headache and double vision, showed a ring-enhanced sellar tumor on MRI, underwent transsphenoidal surgery that revealed a coagulation necrotic adenoma without massive hemorrhage, and showed normal pituitary function after the surgery. Definitive diagnoses were made based on immunohistochemistry of the necrotic cells. The findings were consistent with the presence of selective infarct of a GH adenoma and a prolactinoma that had led to remission of acromegaly and menstrual disturbance, respectively, without pituitary insufficiency. In contrast to hemorrhagic apoplexy, infarctive apoplexy tends to affect only the tumor and thus presents with mild symptoms and lack pituitary deficiencies.

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“…When apoplexy arises in functioning adenomas, it may result in spontaneous remission of the symptoms caused by excess hormone. Spontaneous remission of acromegaly after PA has been previously reported in the literature as case reports [4][5][6][7][8][9][10].…”

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confidence: 86%

Complete Surgical Resolution of Bilateral Total Opthalmoplegia without Visual Field Defect in an Acromegalic Patient Presented with Pituitary Apoplexy

et al. 2007

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Abstract. Pituitary apoplexy (PA), which is one of the most serious life-threatening complications of pituitary adenoma, is characterized by abrupt onset of headache, nausea, vomiting, visual disturbances and oculomotor paresis. Combination of oculomotor cranial nerve paralysis with normal visual fields is very rare in PA. We report a 60-year-old acromegalic man presented with panhypopituitarism and bilateral total opthalmoplegia without a visual field defect. At initial evaluation his clinical findings were compatible with adrenal crisis and eye examination revealed total opthalmoplegia, bilateral ptosis and normal vision. MRI showed a large heterogeneous mass in the pituitary fossa. Although clinical findings due to adrenal crisis improved after glucocorticoid therapy there was no improvement in opthalmoplegia and ptosis. The patient underwent transsphenoidal excision of the pituitary mass. Histological examination revealed an adenoma with large areas of hemorrhagic infarction and most of the cells were positive for GH in immunohistochemical analysis. Although opthalmoplegia was severe at presentation, total recovery was achieved 3 months after transsphenoidal surgery. Therefore the presented case clearly demonstrates that opthalmoplegia without a visual field defect due to PA has a good prognosis and early diagnosis and treatment including surgical decompression are crucially important.

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Pituitary Apoplexy in Acromegaly

Cited by 45 publications

References 0 publications

Corticotroph Cell Adenoma without Typical Manifestations of Cushing's Disease Presenting with Cavernous Sinus Syndrome following Pituitary Apoplexy.

Corticotroph Cell Adenoma without Typical Manifestations of Cushing's Disease Presenting with Cavernous Sinus Syndrome following Pituitary Apoplexy.

Spontaneous Remission of Functioning Pituitary Adenomas without Hypopituitarism following Infarctive Apoplexy: Two Case Reports

Complete Surgical Resolution of Bilateral Total Opthalmoplegia without Visual Field Defect in an Acromegalic Patient Presented with Pituitary Apoplexy

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