Spontaneous infarction in pituitary tumors

Abstract

In addition to progressive endocrine dysfunction and progressive visual loss, pituitary neoplasms may annouce their presence by the more catastrophic alternative of spontaneous tumor infarction. In two patients reported, illness due to the spontaneous infraction of pituitary tumors was heralded by sudden onset of focal headache associated with diplopia. Stupor, confusion, and evidence of increased intracranial pressure occurred without subarachnoid hemorrhage or massive extrasellar extension of tumor. One patient developed inappropriate antidiuretic hormone secretion with spontaneous infarction in a large but clinically silent chromophobe adenoma. In both patients, skull x-rays suggested a long-standing intrasella mass. Both underwent prompt treatment with endocrinologic replacement therapy and subsequent successful transsphenoidal removal of voluminous, infarcted, pituitary masses.

Blindness following pituitary apoplexy: Timing of surgery and neuro-ophthalmic outcome

“…35 This term has also been used to refer to the sudden infarction of non-tumorous pituitary glands. 36 The incidence of pituitary apoplexy varies from 0.6% to 22%, depending on the definition used. 17 If pathological evidence of hemorrhage into pituitary adenomas is taken as the criterion for diagnosis of pituitary apoplexy, then the incidence may vary from 16% to 22%.…”

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

“…However, we now know that ischemic or hemorrhagic necrosis of a pituitary tumor may be entirely silent and is more com mon than classical apoplexy [7,8] and that it may result in spontaneous regression of the tumor or the associated endocrinopathy [11][12][13]. It is only recently recognised that necrosis of the pituitary tumor occurs far more fre quently than anticipated and that the clinical presenta tions can be highly variable [3,5,7,8], Recurrent bleed ing, although well documented, [1,4], is thought to be uncommon [14], Our results suggest that this is not the case as the CT scan and histological findings suggest that recurrent episodes of bleeding is likely to be the rule rather than the exception. Six patients had CT changes indicative of both acute and chronic bleeding and 6 of the 8 surgically treated patients had hemosiderin deposi tion and fibrosis indicative of past bleeding in addition to the acute episode.…”

“…This can be due to a hemorrhage [1,2] or an extensive tumor infarction [3,4]. Little is known about the long term outcome of patients who have experienced apo plexy.…”

“…Little is known about the long term outcome of patients who have experienced apo plexy. Most of the reported information relates to a lim ited experience describing the initial presentations of isolated cases or small series [3][4][5][6]. Even among the larger reported series, limited or no follow-up data is available [7,8].…”

Pituitary apoplexy in acromegaly during bromocriptine therapy

“…Once infarction has occurred, the tumour undergoes haemorrhagic necrosis which expands beyond the size of the original adenoma. However, these ex¬ planations may not be correct, since acute necrotic changes also occur in slow-growing pituitary ade¬ nomas (Conomy et al 1975) as in the present cases and recent angiographie studies have shown that pituitary adenomas may receive their blood supply directly from capsular arteries (Baker 1972 Bromocriptine has a direct action on pituitary adenoma cells of acromegaly to suppress GH re¬ lease (Ishibashi & Yamaji 1978). Its possible antitumour effect is supported by the observation that bromocriptine therapy improved visual field defi¬ cits in acromegalic patients (Wass et al 1977(Wass et al , 1979 as in those with a prolactin-secreting adenoma (Corenblum et al 1975;McGregor et al 1979a,b;George et al 1979;Landolt et al 1979).…”