Precipitating factors in pituitary apoplexy

Biousse, Valérie; Newman, Nancy J.; Oyesiku, Nelson M.

doi:10.1136/jnnp.71.4.542

Cited by 270 publications

(262 citation statements)

References 14 publications

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“…In patients with macroadenomas, the incidence of apoplexy is probably higher (21). The occurrence of pituitary apoplexy has been described following pituitary function tests (36), coronary artery bypass surgery (35,37), cholecystectomy (38), head trauma (39), and vaginal delivery (40). Moreover, apoplexy has been associated with hypertension (35) and anticoagulant therapy (40).…”

Section: Non-functioning Pituitary Macroadenomasmentioning

confidence: 99%

“…The occurrence of pituitary apoplexy has been described following pituitary function tests (36), coronary artery bypass surgery (35,37), cholecystectomy (38), head trauma (39), and vaginal delivery (40). Moreover, apoplexy has been associated with hypertension (35) and anticoagulant therapy (40). The majority of patients with pituitary apoplexy present with ACTH-deficiency (35), establishing the potential life-threatening condition of the clinical syndrome.…”

Section: Non-functioning Pituitary Macroadenomasmentioning

confidence: 99%

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The natural course of non-functioning pituitary macroadenomas

Dekkers¹,

Hammer²,

Keizer³

et al. 2007

eur j endocrinol

167

129

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Objective: The natural history of non-functioning pituitary macroadenomas (NFMA) has not been completely elucidated. Therefore, we evaluated pituitary function, visual fields, and tumor size during long-term follow-up of non-operated patients with NFMA. Design: Follow-up study. Patients: Twenty-eight patients (age 55G3 years) with NFMA, not operated after initial diagnosis, were included. Results: Initial presentation was pituitary insufficiency in 44%, visual field defects in 14%, apoplexy in 14%, and chronic headache in 7% of the patients. The duration of follow-up was 85G13 months. Radiological evidence of tumor growth was observed in 14 out of 28 patients (50%) after duration of follow-up of 118G24 months. Six patients (21%) were operated, because tumor growth was accompanied by visual field defects. Visual impairments improved in all the cases after transsphenoidal surgery. Spontaneous reduction in tumor volume was observed in eight patients (29%). No independent predictors for increase or decrease in tumor volume could be found by regression analysis. Conclusion: Observation alone is a safe alternative for transsphenoidal surgery in selected NFMA patients, without the risk of irreversibly compromising visual function. European Journal of Endocrinology 156 217-224

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Section: Non-functioning Pituitary Macroadenomasmentioning

confidence: 99%

Section: Non-functioning Pituitary Macroadenomasmentioning

confidence: 99%

The natural course of non-functioning pituitary macroadenomas

Dekkers¹,

Hammer²,

Keizer³

et al. 2007

eur j endocrinol

167

129

View full text Add to dashboard Cite

show abstract

“…8,12,13,31,34 However, more recent case series have reported good outcomes with conservative medical therapy. 9,21,23,24 No randomized studies have been conducted to compare the two management strategies, and guidelines propose individualizing therapy depending on the severity of presentation. 30 Most of the literature on pituitary apoplexy consists of relatively small case series.…”

mentioning

confidence: 99%

Management and outcomes of pituitary apoplexy

Singh¹,

Valizadeh²,

Meyer³

et al. 2015

JNS

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OBJECT This study was undertaken to analyze the predisposing factors, clinical presentation, therapeutic management, and clinical recovery in patients with pituitary apoplexy, with an emphasis on the long-term visual, endocrine, and functional outcomes. METHODS The authors performed a retrospective analysis of consecutive cases involving patients treated at Mayo Clinic between 1992 and 2013. Patients were included in the study only if they had 1) abrupt onset of severe headache or visual disturbance in the presence of a pituitary adenoma and 2) radiological or surgical confirmation of a pituitary mass. The primary endpoints of analysis were the visual (ocular motility, visual fields, and visual acuity), endocrine, and functional outcomes (using the modified Rankin Scale). RESULTS Eighty-seven patients were identified (57 males and 30 females, mean age 50.9 years, range 15–91 years). Twenty-two patients (25.3%) had a known pituitary adenoma. Hypertension was the most common associated factor (39%). Headache was the most frequent presenting symptom (89.7%), followed by visual abnormalities (47.1%). Cranial nerve palsies were present in 39% and visual field defects in 34.1%. MRI detected hemorrhage in 89% patients, as compared with 42% detected by CT scan. Sixty-one patients (70.1%) underwent surgery during acute hospitalization (median time from apoplexy 5 days, IQR 3–10 days), 8 (9.2%) had delayed surgery, and 18 (20.7%) were treated conservatively. Histopathological examination revealed adenoma with pure necrosis in 18 (30%), pure hemorrhage in 4 (6.7%), and both in 6 (10%) patients. Four patients died during hospitalization. The average duration of follow-up was 44.2 ± 43.8 months. All survivors were independent and had complete resolution or substantial improvement in eye movements and visual fields at the last follow-up. Many patients needed long-term hormonal replacement with levothyroxine (62.7%) and cortisol (60%). Daily desmopressin was needed in 23% of all surgical patients at 3 months (versus none of the medically treated) and this requirement decreased slightly over time. Regrowth of pituitary adenoma was seen in 7 patients (8.6%). There were no statistically significant differences in any of the outcome measures across the treatment groups. CONCLUSIONS The outcome of most patients with pituitary apoplexy is excellent. Selected patients can be managed conservatively, and patients with severe neuro-ophthalmological deficits treated with early surgery can achieve an excellent recovery.

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“…Although the clinical presentation is variable, common symptoms include headache, nausea and visual deficits. 2,3 This patient experienced bitemporal hemianopsia, a common deficit, as the optic chiasm is vulnerable to stretching by a growing adenoma.…”

mentioning

confidence: 99%

“…They include acute changes in blood flow to the pituitary, stimulation of the pituitary gland and impaired coagulation. 3,4 Impaired coagulation states include patients who were anticoagulated for unstable angina or patients who were thrombocytopenic. 5,6 All patients undergoing PSCT become thrombocytopenic secondary to the preparative regimen given before transplant and may be at increased risk for this complication.…”

mentioning

confidence: 99%