Pituitary tumor apoplexy

Chang, Claudia Veiga; Felı́cio, André Carvalho; Toscanini, Andrea Cecília; Teixeira, Manoel Jacobsen; Cunha-Neto, Malebranche Berardo Carneiro da

doi:10.1590/s0004-282x2009000200033

Cited by 35 publications

(32 citation statements)

References 40 publications

(60 reference statements)

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“…There are no established criteria to define the neuroophthalmological deficit requiring neurosurgical intervention, and recently a scoring tool has been designed, the pituitary apoplexy score (PAS) (111). The retrospective analysis of two large case series revealed significant differences between the PAS in cases treated with emergency surgical intervention, delayed surgery or conservative management (19,111).…”

Section: Surgerymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

Căpățînă

Inder

Karavitaki

et al. 2015

European Journal of Endocrinology

110

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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%

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

Căpățînă

Inder

Karavitaki

et al. 2015

European Journal of Endocrinology

110

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“…It is usually spontaneous, but it can also be induced by numerous precipitating factors (2,3). The underlying mechanism of pituitary apoplexy is in infancy, and some theories have been proposed such as intratumor vasospasm, rapid tumor growth outstripping arterial supply, and fragile neovascularization (4).…”

Section: Introductionmentioning

confidence: 99%

Hypoxia induces hemorrhagic transformation in pituitary adenomas via the HIF-1α signaling pathway

Zhang

Liu²,

Zhao³

et al. 2011

Oncol Rep

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Abstract. The hypoxia inducible factor 1 α (HIF-1α) activity has been associated with various hemorrhagic events. The biological role of HIF-1α in the hemorrhagic transformation of pituitary adenomas remains unknown. We hypothesized that fast growing tumor cells tend to predispose themselves to sublethal hypoxia and activate the HIF-1α signaling pathway, leading to hemorrhagic transformation in pituitary adenomas. Here, we used apoplectic and non-apoplectic pituitary adenomas to determine the involvement of HIF-1α signaling in intratumoral hemorrhage. We employed HIF-1α overexpression/knockdown strategies to examine the association between HIF-1α signaling and hemorrhagic presentation in vitro and in vivo. In support of our hypothesis, compared with nonhemorrhagic pituitary adenomas, higher cellular proliferation was observed in hemorrhagic ones and it correlated with increased HIF-1α signaling. HIF-1α overexpression activated its downstream genes, vascular endothelial growth factor and the proapoptotic BNIP3, in MMQ pituitary adenoma cells and this up-regulation was attenuated by HIF-1 siRNA. In vivo studies using MMQ cell xenografts in nude mice showed that HIF-1α overexpression significantly promoted hemorrhagic transformation. Our study indicates that tumor hypoxia, following rapid tumor growth, may promote hemorrhagic transformation in pituitary adenomas via the HIF-1α signaling pathway.

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“…2,3,8,9,13,16,24) Pituitary apoplexy is characterized by sudden onset of headache, visual impairment, or ophthalmoplegia caused by acute enlargement of the tumor. 3,6,11,26,27,30) Intratumoral hemorrhage is the most common type of hemorrhage, but subarachnoid hemorrhage (SAH), 16,17,19,27) and intra-ventricular hemorrhage 5,21,25) may also result from pituitary apoplexy. Only one case of intracerebral hemorrhage (ICH) has been associated with pituitary apoplexy.…”

Section: Introductionmentioning

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 tumor apoplexy

Cited by 35 publications

References 40 publications

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

Hypoxia induces hemorrhagic transformation in pituitary adenomas via the HIF-1α signaling pathway

Pituitary Apoplexy Manifesting as Massive Intracerebral Hemorrhage

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