Pituitary apoplexy (spontaneous pituitary necrosis)

Sachdev, Y; Gopal, K.; Garg, V. K.; Mongia, S. S.

doi:10.1136/pgmj.57.667.289

Cited by 14 publications

(4 citation statements)

References 10 publications

(9 reference statements)

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“…As we have defined it here, pituitary apoplexy is a rare disorder and in this hospital has occurred in only 13 out of 300 patients with pituitary tumors seen over the last 10 years. Recently, there has been a tendency to classify all types of hemorrhagic pituitary tumors as examples of apoplexy [7,10] regardless of the extent of bleed and the nature of clinical presentation. It is a clin ical rather than a pathological definition.…”

Section: Discussionmentioning

confidence: 99%

Classical Pituitary Apoplexy Presentation and a Follow-Up of 13 Patients

Ahmed¹,

Rifai²,

Al-Jurf³

et al. 1989

Horm Res

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Thirteen patients who presented with signs and symptoms of pituitary disease gave a history of classical pituitary apoplexy. Six presented with acute symptoms and in 7 the history antedated the admission by a mean of 887 days (range 365–2,190 days). All patients had an enlarged eroded sella. CT scans revealed a bleed in the tumor in 11 (histologically confirmed in all 8 patients operated), evidence of residual tumor in 1 and an empty sella (ES) in 1 patient. Hypopituitarism was present in 9, 4 were endocrinologically normal, 8 had visual problems requiring decompressive surgery and radiotherapy (RT) was given to 7 patients. They were subsequently followed for a median period of 730 days (range 365–3,385 days). During this time an empty sella developed in 5, 2 of whom had no surgery or RT; 4 remained endocrinologically normal, and a second hemorrhage occured in 2 patients. Histological evidence of previous bleeds was noted in 6 of the 8 patients treated surgically. We conclude that apoplexy (1) may produce complete or partial tumor destruction with or without preservation of endocrine function; (2) recurrent, often silent, bleeding into a pituitary tumor appears to be a common event; (3) RT should be withheld unless recurrent tumor is documented (since at least 2 patients in this study have experienced spontaneous resolution of the tumor); and (4) the presence of an enlarged eroded fossa with an ES is reasonable presumptive evidence of an infarction of a pre-existing pituitary tumor.

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Section: Discussionmentioning

confidence: 99%

Classical Pituitary Apoplexy Presentation and a Follow-Up of 13 Patients

Ahmed¹,

Rifai²,

Al-Jurf³

et al. 1989

Horm Res

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“…However, some patients treated conservatively recover without sequelae (95), while recovery of neuroophthalmic function can also occur after delayed decompression (at an average of 19 days after presentation) (93). Therefore, the debate around the optimal management strategy still persists.…”

Section: Managementmentioning

confidence: 99%

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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“…Two distinct extreme manifestations of acute apoplexy are observed in health centers: patients suspected with pituitary apoplexy may recover immediately without neurological and endocrinological deficiency or deteriorate intensely owing to mass effects and the secondary subarachnoid hemorrhage (SAH) [5]. Moreover, in some cases, the tumor may be completely controlled after apoplexy while the remnants may continue to grow in other cases [6,7]. Doctors including emergency physicians, ophthalmologists, endocrinologists, and neurosurgeons are facing critical issues raised by the management of pituitary apoplexy.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for the incidence of apoplexy in pituitary adenoma: a single-center study from southwestern China

Yuan

Qiao

et al. 2020

Chin Neurosurg Jl

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Background: Although the incidence and clinical manifestations of pituitary apoplexy were reported by a few researches, the results are not consistent. This study aimed to explore the risk factors associated with an incidence of apoplexy in pituitary adenomas. Methods: The clinical information of 843 patients with pituitary adenoma from the Department of Neurological Surgery, 1st Affiliated Hospital of Kunming Medical University, was reviewed. The incidence, clinical manifestation, and potential risk factors for pituitary apoplexy were analyzed by a case-control study. Results: In total, 121 patients (14.4%) with macroadenoma were suffered from pituitary apoplexy. Headache, vomiting, and visual impairment are the top 3 symptoms for the pituitary apoplexy. Logistic regression results showed that the hypertension(hypertension vs non-hypertension OR = 2.765, 95%CI: 1.41~5.416), tumor type (negative staining vs. positive staining, OR = 1.501, 95%CI:1.248~5.235), and tumor size (diameter > 2 cm vs. diameter ≤ 2 cm, OR = 3.952, 95%CI:2.211~7.053) are independent factors associated with pituitary apoplexy. Conclusion: Our results indicate that the risk factors for the incidence of pituitary apoplexy depend mainly on properties of the tumor itself (tumor size and pathologic type) and the blood pressure of patients.

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Pituitary apoplexy (spontaneous pituitary necrosis)

Cited by 14 publications

References 10 publications

Classical Pituitary Apoplexy Presentation and a Follow-Up of 13 Patients

Classical Pituitary Apoplexy Presentation and a Follow-Up of 13 Patients

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

Risk factors for the incidence of apoplexy in pituitary adenoma: a single-center study from southwestern China

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