Sphenoid sinus mucosal thickening in the acute phase of pituitary apoplexy

Waqar, Mueez; McCreary, Robert; Kearney, Tara; Karabatsou, Konstantina; Gnanalingham, Kanna

doi:10.1007/s11102-017-0804-z

Cited by 21 publications

(23 citation statements)

References 15 publications

(38 reference statements)

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“…The identification of known respiratory pathogens from the sinuses of PA patients could be indicative of an infective aetiology. In support of this is the observation of increased prevalence of sphenoid sinus mucosal thickening in patients presenting with PA, most notably within the first week of the onset of symptoms [ 2 , 17 , 18 ]. Infection is also a known risk factor for other cerebral vascular phenomena, such as cavernous sinus syndrome [ 19 ].…”

Section: Discussionmentioning

confidence: 93%

“…We and others have observed a high incidence of abnormal sphenoid sinus changes in PA [ 2 ]. In a recent study we noted that sphenoid sinus mucosal thickening (SSMT) was present in 62% of PA patients compared to just 6% of a control group of non-functioning pituitary adenomas (NFPAs) [ 2 ]. The aetiology of SSMT in PA is unknown and possibilities include inflammation or infection.…”

Section: Introductionmentioning

confidence: 99%

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Sphenoid sinus microbiota in pituitary apoplexy: a preliminary study

et al. 2017

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PurposeThere is a high incidence of abnormal sphenoid sinus changes in patients with pituitary apoplexy (PA). Their pathophysiology is currently unexplored and may reflect an inflammatory or infective process. In this preliminary study, we characterised the microbiota of sphenoid sinus mucosa in patients with PA and compared findings to a control group of surgically treated non-functioning pituitary adenomas (NFPAs).MethodsIn this prospective observational study of patients undergoing trans-sphenoidal surgery for PA or NFPA, sphenoid sinus mucosal specimens were microbiologically profiled through PCR-cloning of the 16S rRNA gene.ResultsTen patients (five with PA and five with NFPAs) with a mean age of 51 years (range 23–71) were included. Differences in the sphenoid sinus microbiota of the PA and NFPA groups were observed. Four PA patients harboured Enterobacteriaceae (Enterobacter spp., N = 3; Escherichia coli, N = 1). In contrast, patients with NFPAs had a sinus microbiota more representative of health, including Staphylococcus epidermidis (N = 2) or Corynebacterium spp. (N = 2).ConclusionsPA may be associated with an abnormal sphenoid sinus microbiota that is similar to that seen in patients with sphenoid sinusitis.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Sphenoid sinus microbiota in pituitary apoplexy: a preliminary study

et al. 2017

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“…Preoperative MRI scans were reviewed by SR and DB to determine lesion volume as described previously (4/3 × : × radius 3 ) [14].…”

Section: Imaging Reviewmentioning

confidence: 99%

Pre- and postoperative need for pituitary hormone replacement in non-adenomatous sellar and parasellar lesions: importance of the sellar encroachment score

et al. 2020

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Background Pre-/postoperative pituitary endocrine deficiencies in patients with sellar/parasellar non-adenomatous lesions are poorly described and studies have not considered the effect of sellar invasion on endocrine outcome. The aim of this study was to relate the need for pituitary hormone replacement pre-/postoperatively, with sellar invasion, in non-adenomatous sellar/parasellar lesions. Methods Single-centre review of adults with histologically confirmed non-adenomatous sellar/parasellar lesion and follow-up ≥ 3 months or until postop radiotherapy. Pituitary dysfunction was defined by hormone replacement. The sellar encroachment score (0–6) was calculated as the sum of the thirds of radiological encroachment into the sellar region in the coronal and sagittal planes. Multivariate analysis with binary logistic regression was used to determine factors associated with pituitary hormone replacement. Results One hundred and seventeen patients were included with a median age of 49 years (range 16–84 years) and median follow-up of 13 months. Surgery was trans-sphenoidal (53%), trans-cranial (36%) or a combination (11%). The commonest histology types were meningioma (n = 33, 28%) and craniopharyngioma (n = 20, 17%). The median sellar encroachment score was 6 (range 0–6). Most (n = 86, 74%) did not require pituitary hormone replacement preoperatively. The need for pituitary hormones increased after surgery in 41 (35%) patients. In multivariate analysis, the sellar encroachment score was the only factor predictive of pre- (OR = 2.6, 95% CI = 1.2–5.5; p = 0.01) and postoperative risk of new pituitary hormone replacement (OR = 4.1, 95% CI = 1.7–10.1, p = 0.002). Conclusion A significant proportion of these patients present with need for pituitary hormone replacement that may worsen postoperatively. The degree of sellar encroachment is predictive of pituitary hormone replacement status pre-/postoperatively.

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“…In pituitary apoplexy patients, some authors reported the thickening of the sphenoid sinus mucosa related to venous engorgement in this region as an excellent sign that is present from the early stage, a reversible condition on follow-up studies that generally improves spontaneously [104]. This thickening does not indicate infectious sinusitis and thus does not rule out the surgical transsphenoidal route [103,105].…”

Section: Pituitary Imagingmentioning

confidence: 99%

“…Some published series have demonstrated the great value of special techniques as T2-weighted gradient echo to detect pituitary hemorrhage in the acute phase and chronic phase. MRI diffusion-weighted images (DWI) can be also be helpful in rare cases of ischemic pituitary necrosis without hemorrhage [105][106][107].…”

Section: Pituitary Diseasesmentioning

confidence: 99%

Pituitary Apoplexy

Jemel¹,

Alaya²,

Boubaker³

et al. 2019

Pituitary Diseases

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Pituitary apoplexy is a rare clinical emergency due to acute ischemic infarction or hemorrhage of the pituitary gland. As this disorder most often involves a pituitary adenoma, especially nonfunctioning tumors, the syndrome should be referred to as pituitary tumor apoplexy. The precise physiopathology is not completely clear. Although in most cases it occurs spontaneously, pituitary apoplexy can be precipitated by many risk factors. The main symptom is headache of sudden onset associated with visual disturbances, signs of meningeal irritation, and/or endocrine dysfunction. Corticotropic deficiency is a potentially life-threatening disorder. Magnetic resonance imaging is the most sensitive to confirm the diagnosis by revealing a pituitary tumor with hemorrhagic and/or necrotic components. Earlier studies used to consider urgent decompression of the lesion surgically, but nowadays, more recent studies favor conservative management in selected patients (those without important visual acuity or field defects and with normal consciousness). This wait-and-see approach gives evidence of excellent outcomes in terms of oculomotor palsy, pituitary function, and subsequent tumor growth. Surgical decompression may be necessary in some cases. Once the acute phase is over, the patient should be reevaluated for hormonal deficiencies. Moreover, spontaneous remission of syndromes, such as acromegaly, may be caused by pituitary adenoma apoplexy.

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Sphenoid sinus mucosal thickening in the acute phase of pituitary apoplexy

Cited by 21 publications

References 15 publications

Sphenoid sinus microbiota in pituitary apoplexy: a preliminary study

Sphenoid sinus microbiota in pituitary apoplexy: a preliminary study

Pre- and postoperative need for pituitary hormone replacement in non-adenomatous sellar and parasellar lesions: importance of the sellar encroachment score

Pituitary Apoplexy

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