Pituitary Apoplexy Precipitated by Systemic Chemotherapy

Hamrick, Forrest; Findlay, Matthew C.; Rennert, Robert C.; Budohoski, Karol P.; Couldwell, William T.

doi:10.7759/cureus.23004

Cited by 2 publications

(3 citation statements)

References 19 publications

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“…Pituitary apoplexy that was temporally related to systemic chemotherapy delivery has been reviewed [ 9 ]. One week after beginning chemotherapy with bleomycin, etoposide, and cisplatin, a 31-year-old male with newly diagnosed metastatic testicular cancer had headaches, nausea, and a deficiency in his right side of the visual field.…”

Section: Discussionmentioning

confidence: 99%

Retrospection of Seldom-Known Causes and Presentations of Partial Empty Sella Syndrome

Khanna,

Kumar

2023

Cureus

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Pituitary gland shrinkage or flattening obscures it from view on an MRI, giving the impression that it is an empty sella. On the other hand, if some viable pituitary gland tissue is still seen on the MRI scan, a diagnosis of partial empty sella can be made. Diminished physiological and functional reserve in the elderly can result in a bad prognosis if not treated early. Therefore, there is a need to become familiar with fewer known causes and presentations of the empty sella or partial empty sella syndrome in older patients. We report a case of a 71-year-old female with multiple known ailments presenting with hypotension as the sole symptom. It urged us to investigate further and reach the root cause as partial empty sella syndrome with panhypopituitarism.

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Section: Discussionmentioning

confidence: 99%

Retrospection of Seldom-Known Causes and Presentations of Partial Empty Sella Syndrome

Khanna,

Kumar

2023

Cureus

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“…Other vascular and clotting triggers include Takotsubo cardiomyopathy [ 213 ], heparin-induced thrombocytopenia [ 35 ], thrombocytopenia of other causes [ 97 , 208 ], and polycythemia [ 108 ]. Medical treatments in point are further on (at the statistical level of rare case reports): androgen deprivation therapy for prostate cancer [ 52 , 88 , 99 , 157 , 168 ], systemic chemotherapy like bleomycin, etoposide, cisplatin [ 184 ], doxorubicin, cyclophosphamide [ 207 ], and thyroxine therapy [ 61 ].…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

“…A large number of patients required hormonal replacement due to PA-associated hypopituitarism manifested as hypocortisolism which is the most important aspect in terms of an immediate life-threatening approach [ 25 , 29 , 30 , 31 , 56 , 65 , 66 , 75 , 80 , 90 , 92 , 123 , 128 , 144 , 163 , 168 , 169 , 208 ], central hypothyroidism [ 25 , 56 , 65 , 66 , 72 , 75 , 101 , 109 , 123 , 144 , 163 , 168 , 169 , 180 , 184 , 200 ], and hypogonadotropic hypogonadism [ 25 , 56 , 65 , 66 , 72 , 109 , 128 , 168 , 169 , 180 , 198 ]. GH deficiency was also reported [ 109 , 128 , 1...…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

et al. 2023

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Various complications of pituitary neuroendocrine tumors (PitNET) are reported, and an intratumor hemorrhage or infarct underlying pituitary apoplexy (PA) represents an uncommon, yet potentially life-threatening, feature, and thus early recognition and prompt intervention are important. Our purpose is to overview PA from clinical presentation to management and outcome. This is a narrative review of the English-language, PubMed-based original articles from 2012 to 2022 concerning PA, with the exception of pregnancy- and COVID-19-associated PA, and non-spontaneous PA (prior specific therapy for PitNET). We identified 194 original papers including 1452 patients with PA (926 males, 525 females, and one transgender male; a male-to-female ratio of 1.76; mean age at PA diagnostic of 50.52 years, the youngest being 9, the oldest being 85). Clinical presentation included severe headache in the majority of cases (but some exceptions are registered, as well); neuro-ophthalmic panel with nausea and vomiting, meningism, and cerebral ischemia; respectively, decreased visual acuity to complete blindness in two cases; visual field defects: hemianopia, cranial nerve palsies manifesting as diplopia in the majority, followed by ptosis and ophthalmoplegia (most frequent cranial nerve affected was the oculomotor nerve, and, rarely, abducens and trochlear); proptosis (N = 2 cases). Risk factors are high blood pressure followed by diabetes mellitus as the main elements. Qualitative analysis also pointed out infections, trauma, hematologic conditions (thrombocytopenia, polycythemia), Takotsubo cardiomyopathy, and T3 thyrotoxicosis. Iatrogenic elements may be classified into three main categories: medication, diagnostic tests and techniques, and surgical procedures. The first group is dominated by anticoagulant and antiplatelet drugs; additionally, at a low level of statistical evidence, we mention androgen deprivation therapy for prostate cancer, chemotherapy, thyroxine therapy, oral contraceptives, and phosphodiesterase 5 inhibitors. The second category includes a dexamethasone suppression test, clomiphene use, combined endocrine stimulation tests, and a regadenoson myocardial perfusion scan. The third category involves major surgery, laparoscopic surgery, coronary artery bypass surgery, mitral valvuloplasty, endonasal surgery, and lumbar fusion surgery in a prone position. PA in PitNETs still represents a challenging condition requiring a multidisciplinary team from first presentation to short- and long-term management. Controversies involve the specific panel of risk factors and adequate protocols with concern to neurosurgical decisions and their timing versus conservative approach. The present decade-based analysis, to our knowledge the largest so far on published cases, confirms a lack of unanimous approach and criteria of intervention, a large panel of circumstantial events, and potential triggers with different levels of statistical significance, in addition to a heterogeneous clinical picture (if any, as seen in subacute PA) and a spectrum of evolution that varies from spontaneous remission and control of PitNET-associated hormonal excess to exitus. Awareness is mandatory. A total of 25 cohorts have been published so far with more than 10 PA cases/studies, whereas the largest cohorts enrolled around 100 patients. Further studies are necessary.

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Pituitary Apoplexy Precipitated by Systemic Chemotherapy

Cited by 2 publications

References 19 publications

Retrospection of Seldom-Known Causes and Presentations of Partial Empty Sella Syndrome

Retrospection of Seldom-Known Causes and Presentations of Partial Empty Sella Syndrome

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

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