Pituitary Apoplexy in Five Patients with Pituitary Tumours

Epstein, Steven E; Pimstone, B. L.; Villiers, J. C. De; Jackson, W. P. U.

doi:10.1136/bmj.2.5756.267

Cited by 83 publications

(47 citation statements)

References 6 publications

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“…Impaired consciousness is also a frequent indication for surgery (108,110). Ocassionally, complete recovery of the mental state with conservative management has been reported, but generally the course is variable and unpredictable (23, 95) making urgent decompression the preferred option.…”

Section: Surgerymentioning

confidence: 99%

“…For patients with altered consciousness or VF/VA defects, early surgical intervention (preferably within 1 week) is indicated (91,108,110,113) and is associated with improved visual (2) and possibly endocrinological (86,113) outcome. Delayed surgery (if early intervention is not possible) is still beneficial, especially in terms of vision (2).…”

Section: Management: Summarymentioning

confidence: 99%

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MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

Căpățînă

Inder

Karavitaki

et al. 2015

European Journal of Endocrinology

125

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Pituitary tumour apoplexy (PA) is a rare clinical syndrome that occurs as a result of acute haemorrhage and/or infarction within a frequently undiagnosed pituitary tumour. The sudden enlargement of the pituitary mass undergoing PA is responsible for a wide range of acute symptoms/signs (severe headache, visual loss, diplopia, hypopituitarism, impaired consciousness) which, together with the radiological evidence of a pituitary lesion, establish the diagnosis. The optimal care of PA requires involvement of a multidisciplinary team including endocrinologist, neurosurgeon, neuroophthalmologist and the management strategy that depends on the clinical manifestations, as well as the presence of co-morbidities. Prompt surgical decompression is initially indicated in cases with severe or progressive impairment of the visual acuity or the visual fields or with altered mental state and leads to visual and neurological recovery in most of the patients. The patients with mild, stable clinical picture (including those with isolated ocular palsies) can be managed conservatively (support of fluid and electrolyte balance and stress doses of steroids in most cases) with favourable visual and neurological outcome. Frequent reassessment is mandatory because the clinical course can be unpredictable; if progression of symptoms occurs, later elective surgery is indicated and is beneficial, especially in terms of visual outcome. The endocrinological outcome is less favourable, irrespective of the treatment option, with many patients remaining on long-term replacement therapy. Despite the above guidelines, clear proof of optimal outcomes in the form of randomised controlled trials is lacking. Regrowth of the pituitary tumour years after a PA episode is possible and patients require long-term surveillance.

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Section: Surgerymentioning

confidence: 99%

Section: Management: Summarymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

Căpățînă

Inder

Karavitaki

et al. 2015

European Journal of Endocrinology

125

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“…The most important differential diagnosis to consider are aneurismal subarachnoid hemorrhage and bacterial meningitis. Midbrain infarction and cavernous sinus thrombosis, although much less common, also must be excluded 2,8 . Our patient had no signs of intracranial hemorrhage at the computed tomography, and a normal lumbar puncture excluded the diagnosis of meningitis.…”

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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“…One theory is that rapid tumor growth may outstrip arterial supply, thereby causing ischemic necrosis and hemorrhage. 8 The size of the adenoma appears to be a major factor, but even microadenomas can bleed. Another theory is that the tumor growing inside the narrow space situated between the pituitary stalk and diaphragm sellae leads to constriction of the thin vascular network and finally ischemia, necrosis, and hemorrhage on the anterior lobe and tumor tissue.…”

Section: -7mentioning

confidence: 99%

Pituitary Apoplexy presenting as Bilateral Ophthalmoplegia

Dhiware¹,

Deshpande²,

Patkar³

et al. 2017

MGM Journal of Medical Sciences

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Pituitary apoplexy is an endocrinological emergency, usually occurring in a pituitary adenoma and is caused by sudden onset hemorrhage and ischemic necrosis of the pituitary gland. Sudden-onset headache along with vomiting is the usual presenting feature. Signs of meningism, however, occur late and are not a characteristic feature. These may be associated with other neurological features like disturbances of consciousness, vertigo, and hemiparesis. Ocular features include marked reduction in the visual acuity with bitemporal hemianopia, diplopia, and ophthalmoplegia due to ocular motor nerve palsies. Acute pituitary apoplexy is unpredictable and should be considered in any patient with abrupt neuro-ophthalmological deterioration associated with headache. We report a unique case of pituitary apoplexy with bilateral total ophthalmoplegia having complete oculomotor nerve palsy in one eye and pupil-sparing oculomotor nerve palsy in the other.

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Pituitary Apoplexy in Five Patients with Pituitary Tumours

Cited by 83 publications

References 6 publications

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

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

Pituitary Apoplexy presenting as Bilateral Ophthalmoplegia

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