Subclinical pituitary apoplexy with preserved pituitary functions

Garg, MK; Pathak, Harish; Singh, Giriraj

doi:10.4103/2230-8210.126597

Cited by 4 publications

(5 citation statements)

References 5 publications

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“…Severe headache and hyponatremia were more frequent in the acute group whereas the ratio of individuals who were referred to surgery was similar between the two subgroups [ 166 ]. Garg M et al described the case of a 22-year-old female with vision reduction as the single symptom [ 197 ]. Klimko A et al also reported a 41-year-old acromegalic male with subacute PA and panhypopituitarism [ 148 ].…”

Section: Discussionmentioning

confidence: 99%

“…( Table 1 ) Headache was severe, often described as the most painful headache episode an individual has ever experienced, and graded, for example, as high as 9 on a scale from 0 to 10, with 10 being the most severe in one study [ 31 ]. For practical purposes we point out that headache was absent in some cases; thus, an index of suspicion should be provided by other endocrine and non-endocrine clinical elements [ 43 , 86 , 196 , 197 , 198 , 199 , 200 , 201 , 202 , 203 , 204 , 205 , 206 , 207 , 208 , 209 , 210 , 211 , 212 , 213 , 214 , 215 , 216 ]. For instance, Enatsu et al reported a 65-year-old woman admitted for a nonfunctioning pituitary adenoma-associated PA who presented third cranial nerve palsy and sudden decrease in visual acuity unaccompanied by headache [ 196 ].…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

“…Complete blindness was reported in two papers [ 199 , 212 ]. Visual field defects varied from (mostly common) hemianopia [ 33 , 39 , 55 , 80 , 126 , 135 , 179 , 187 , 197 ] to cranial nerve palsies manifesting as diplopia in the majority of these cases [ 32 , 34 , 35 , 49 , 50 , 58 , 63 , 66 , 68 , 75 , 84 , 85 , 91 , 92 , 114 , 115 , 117 , 127 , 130 , 142 , 147 , 150 , 157 , 163 , 164 , 186 , 191 , 194 , 195 , 207 , 214 ] followed by ptosis [ 34 , 35 , 50 , 59 , 75 , 77 , 79 ,…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

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Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

et al. 2023

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Various complications of pituitary neuroendocrine tumors (PitNET) are reported, and an intratumor hemorrhage or infarct underlying pituitary apoplexy (PA) represents an uncommon, yet potentially life-threatening, feature, and thus early recognition and prompt intervention are important. Our purpose is to overview PA from clinical presentation to management and outcome. This is a narrative review of the English-language, PubMed-based original articles from 2012 to 2022 concerning PA, with the exception of pregnancy- and COVID-19-associated PA, and non-spontaneous PA (prior specific therapy for PitNET). We identified 194 original papers including 1452 patients with PA (926 males, 525 females, and one transgender male; a male-to-female ratio of 1.76; mean age at PA diagnostic of 50.52 years, the youngest being 9, the oldest being 85). Clinical presentation included severe headache in the majority of cases (but some exceptions are registered, as well); neuro-ophthalmic panel with nausea and vomiting, meningism, and cerebral ischemia; respectively, decreased visual acuity to complete blindness in two cases; visual field defects: hemianopia, cranial nerve palsies manifesting as diplopia in the majority, followed by ptosis and ophthalmoplegia (most frequent cranial nerve affected was the oculomotor nerve, and, rarely, abducens and trochlear); proptosis (N = 2 cases). Risk factors are high blood pressure followed by diabetes mellitus as the main elements. Qualitative analysis also pointed out infections, trauma, hematologic conditions (thrombocytopenia, polycythemia), Takotsubo cardiomyopathy, and T3 thyrotoxicosis. Iatrogenic elements may be classified into three main categories: medication, diagnostic tests and techniques, and surgical procedures. The first group is dominated by anticoagulant and antiplatelet drugs; additionally, at a low level of statistical evidence, we mention androgen deprivation therapy for prostate cancer, chemotherapy, thyroxine therapy, oral contraceptives, and phosphodiesterase 5 inhibitors. The second category includes a dexamethasone suppression test, clomiphene use, combined endocrine stimulation tests, and a regadenoson myocardial perfusion scan. The third category involves major surgery, laparoscopic surgery, coronary artery bypass surgery, mitral valvuloplasty, endonasal surgery, and lumbar fusion surgery in a prone position. PA in PitNETs still represents a challenging condition requiring a multidisciplinary team from first presentation to short- and long-term management. Controversies involve the specific panel of risk factors and adequate protocols with concern to neurosurgical decisions and their timing versus conservative approach. The present decade-based analysis, to our knowledge the largest so far on published cases, confirms a lack of unanimous approach and criteria of intervention, a large panel of circumstantial events, and potential triggers with different levels of statistical significance, in addition to a heterogeneous clinical picture (if any, as seen in subacute PA) and a spectrum of evolution that varies from spontaneous remission and control of PitNET-associated hormonal excess to exitus. Awareness is mandatory. A total of 25 cohorts have been published so far with more than 10 PA cases/studies, whereas the largest cohorts enrolled around 100 patients. Further studies are necessary.

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Section: Discussionmentioning

confidence: 99%

Section: Pitnet Complicated With Pamentioning

confidence: 99%

Section: Pitnet Complicated With Pamentioning

confidence: 99%

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Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

et al. 2023

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“…Therefore, this condition can be a possible evolution for adenoma or one of their revelation's ways. Despite that it's described as a major emergency, PA is described as the mechanism of spontaneous remission in secreting adenoma as it was reported in a few cases of acromegaly (4,5).beyond all of these scenarios, PA could be subclinical without typical symptoms as headache or visual acuity deterioration (6).…”

Section: Introductionmentioning

confidence: 99%

Necrotic Apoplexy of Pituitary Adenoma; A Report of Three Cases

FELISSI¹

2023

SVOANE

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Apoplexy is relatively a rare clinical expression or revelation of pituitary adenoma. Necrotic apoplexy is a subgroup with unique findings in its different aspects. Early surgical resection through the transsphenoidal route is the main modality for their management. We report three cases of patients with necrotic apoplexy. we reviewed the circumstances of revelation, the imaging features, surgical findings, and the results of histological analysis. The age of patients ranged between 22 and 53 years old. All patients complained of headaches and visual disorders. At the MRI evaluation, they had the same radiological features of necrotic apoplexy. They received endoscopic endonasal surgery for the resection and the histological analysis confirmed the presence of necrosis areas in the sampled tissues. Necrotic apoplexy is a rare and unique clinical entity. At the imaging, it appears as a solid sellar mass, iso to hyperintense in both sequences T1 and T2. during the surgical removal, the lesion is yellowish and poorly bleeding without hemorrhagic contents. The histological studies reveal large areas of necrosis in similar lesions.

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“…Subclinical pituitary apoplexy, defined by intratumor hemorrhage and necrosis without clinical presentation of headache and other symptoms, is more common than classical apoplexy and occurs in up to 22% of pituitary tumor patients. 5 Classical pituitary apoplexy generally presents with an acute onset of symptoms. While the most frequently reported complaint is sudden onset of severe headache, other common manifestations include nausea, vomiting, visual impairment, ophthalmoplegia, and altered consciousness.…”

Section: Introductionmentioning

confidence: 99%

Infarctive Apoplexy of Previously Healthy Pituitary Glands: A Small Case Series and Literature Review

et al. 2023

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Introduction We present two cases of suspected pituitary apoplexy found instead to be infarcted pituitary glands without histopathologic evidence of neoplastic cells, likely resulting from spontaneous infarction of previously healthy pituitary glands. Case Presentations The first case is a 55-year-old man who presented with a pulsating headache, nausea, and several months of decreased libido, polyuria, and polydipsia. Magnetic resonance imaging (MRI) revealed a rim-enhancing sellar/suprasellar mass with evidence of recent hemorrhage on the right. Testosterone, follicle-stimulating hormone, and luteinizing hormone levels were suppressed. Analysis of the resected specimen showed fibrocollagenous tissue with evidence of old hemorrhage and microscopic focus of necrotic tissue. The second case is a 56-year-old man who presented with a throbbing headache, associated nausea, and 6 weeks of polyuria and polydipsia. Testosterone levels were found to be low, and 8-hour water deprivation test showed evidence for partial diabetes insipidus. MRI revealed a mass on the right side of the pituitary gland, with evidence of likely hemorrhage on the left. Analysis of the resected specimen showed necrotic tissue without neoplastic cells. Conclusion When evaluating small pituitary lesions in patients presenting with indolent onset of pituitary insufficiency, there should be a high degree of suspicion for an infarcted pituitary gland.

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Subclinical pituitary apoplexy with preserved pituitary functions

Cited by 4 publications

References 5 publications

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

Necrotic Apoplexy of Pituitary Adenoma; A Report of Three Cases

Infarctive Apoplexy of Previously Healthy Pituitary Glands: A Small Case Series and Literature Review

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