Silent Pituitary Apoplexy: Subclinical Infarction of an Adrenocorticotropin-Producing Pituitary Adenoma&

Abstract

A young woman developed intermittent headaches and progressive hyperpigmentation after bilateral adrenalectomy for Cushing's disease. Results of sellar polytomography were abnormal. Her plasma ACTH levels increased to 4750-7340 pg/ml and did not rise with insulin-induced hypoglycemia. Although she experienced no clinical features associated with spontaneous infarction of a pituitary tumor, plasma ACTH levels fell to 474-575 pg/ml, and hemorrhagic necrosis was found in a 5-mm chromophobe adenoma at transsphenoidal surgery. Postoperatively, ACTH levels returned to normal (51-88 pg/ml), with the rest of her anterior pituitary function remaining intact 4 yr later. Spontaneous infarction of pituitary microadenomas may be subclinical, resulting in improvement of pituitary hormone hypersecretion without impairment of other anterior pituitary hormone secretion.

Pituitary Hemorrhage : Classification and Related Factors

“…Some hemorrhage is extensive and may eventually destroy most or all of the pituitary adenoma; patients present with mild symptoms, or even be asymptomatic. These cases of asymptomatic or mild symptomatic pituitary hemorrhage or infarction have been termed "subacute pituitary apoplexy" or "subclinical pituitary apoplexy" 7,15,19) . In these cases, diagnosis is often delayed or neglected 15) .…”

“…The prevalence of pituitary apoplexy presenting with clinical syndrome in several large series of surgically treated pituitary adenoma cases varied between 0.6% and 10% and is usually below 5% 7,12,13,15,19,24) . However, the incidence of pituitary adenoma hemorrhage including asymptomatic intratumoral hemorrhage or subclinical apoplexy is much higher, and has been observed in 14 -22% of surgically resected adenomas 12,16,19,24) .…”

Amelioration of Acromegaly after Pituitary Infarction Due to Gastrointestinal Hemorrhage from Gastric Ulcer.

“…Selective infarction of the tumor probably makes this patient's event clinically silent. Although asymptomatic pituitary apoplexy is sometimes referred to in the literature as silent [8], the term silent pituitary infarction would be more accurate in this case.…”

Prolactinoma With a High Adrenocorticotropic Hormone Level Caused by Meningitis-Case Report-

“…The serum prolactin titer due to tumor cells was decreased because the tumor cells had been compressed and destroyed by the intratumoral hemorrhage. 2) The serum prolactin titer increased after the disappearance of tumor cells compressed by the intratumoral hematoma. The serum prolactin titer is usually correlated with the tumor size of pituitary prolactinomas.…”