Sudden Death from Pituitary Apoplexy in a Patient Presenting with an Isolated Sixth Cranial Nerve Palsy

Warwar, Ronald E.; Bhullar, Shaminder S; Pelstring, Richard J; Fadell, Ronald J

doi:10.1097/01.wno.0000223270.01813.57

Cited by 35 publications

(22 citation statements)

References 7 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Death due to presumed arrhythmia has been noted in association with thyrotoxicosis [39] and abuse of thyroid hormone [401]. Pituitary and hypothalamic region pathology [402] including Wegener's granulomatosis [403], 'pituitary apoplexy' [404], lymphoplasmocytic infiltration/lymphocytic hypophysitis [405,406] and sarcoidosis [407] have been reported to be responsible for sudden death.…”

Section: Central Nervous System Causes Of Sudden Deathmentioning

confidence: 99%

Sudden adult death

Langlois

2009

Forensic Sci Med Pathol

View full text Add to dashboard Cite

In the investigation of sudden death in adults, channelopathies, such as long QT syndrome, have risen to the fore in the minds of forensic pathologists in recent years. Examples of these disorders are touched upon in this review as an absence of abnormal findings at postmortem examination is characteristic and the importance of considering the diagnosis lies in the heritable nature of these conditions. Typically, a diagnosis of a possible channelopathy is evoked as an explanation for a 'negative autopsy' in a case of apparent sudden natural death. However, the one potential adverse effect of this approach is that subtle causes of sudden death may be overlooked. The intention of this article is to review and discuss potential causes of sudden adult death (mostly natural) that should be considered before resorting to a diagnosis of possible channelopathy. Nonetheless, it becomes apparent that many of the potential causes of sudden death can have a genetic basis. Thus, it becomes an important consideration that there may be a genetic basis to sudden death that extends beyond the negative autopsy.

show abstract

Section: Central Nervous System Causes Of Sudden Deathmentioning

confidence: 99%

Sudden adult death

Langlois

2009

Forensic Sci Med Pathol

View full text Add to dashboard Cite

show abstract

“…Clinical presentation may be catastrophic, and mimic other intracranial pathologies [4][5][6] . PA is rarely complicated by cerebral ischemia whose etiology may be difficult to determine [7][8][9][10][11][12][13] .…”

Section: Introductionmentioning

confidence: 97%

Vasospasm and Cerebral Infarction from Pituitary Apoplexy

et al. 2010

View full text Add to dashboard Cite

Pituitary apoplexy is a potentially life-threatening acute or subacute clinical syndrome occurring from enlargement of the pituitary gland, and pituitary insufficiency, from hemorrhage or ischemia from an unknown pituitary lesion, most frequently being a non-functioning macroadenoma. A close, and multidisciplinary management is required. The purpose of this case report is to increase awareness to pituitary apoplexy presentation and management by reporting clinical features and neuroradiological findings observed in a 70-year-old patient with an unknown pituitary lesion. He presented with pituitary apoplexy and brain ischemia at magnetic resonance imaging (MRI) including diffusion-weighted imaging (DWI), and apparent diffusion coefficient (ADC) maps. MR angiography (MRA) showed diffuse vasospasm of anterior and posterior circulation. Both MRI and cytochemical examination of the cerebrospinal fluid ruled out subarachnoid hemorrhage. Due to concomitant diseases, and absence of visual deficit, the management was conservative by medical and substitutive therapy, without surgery. Clinical follow-up showed clearcut improvement, and this was consistent with MRI and MRA evidence of vasospasm regression, and clearcut pituitary lesion shrinkage. Pituitary lesions with hemorrhagic infarction presenting with pituitary apoplexy may be associated with vasospasm and brain ischemia at diagnosis, also in the absence of subarachnoid hemorrhage. A correct MR evaluation of patients with PA should include DWI, ADC maps, and MRA. Notably, early diagnosis of PA-associated vasospasm and cerebral ischemia avoids the possibility of their detection only after neurosurgery.

show abstract

“…Cases of spontaneous biochemical remission after PA have been reported for GH-secreting (120,121,122), ACTH-secreting (18,123,124) and prolactin-secreting (122) tumours. However, in a large case series, 90% of the functioning tumours remained active following PA, the majority of which required surgery (19).…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

Căpățînă

Inder

Karavitaki

et al. 2015

European Journal of Endocrinology

124

View full text Add to dashboard Cite

Pituitary tumour apoplexy (PA) is a rare clinical syndrome that occurs as a result of acute haemorrhage and/or infarction within a frequently undiagnosed pituitary tumour. The sudden enlargement of the pituitary mass undergoing PA is responsible for a wide range of acute symptoms/signs (severe headache, visual loss, diplopia, hypopituitarism, impaired consciousness) which, together with the radiological evidence of a pituitary lesion, establish the diagnosis. The optimal care of PA requires involvement of a multidisciplinary team including endocrinologist, neurosurgeon, neuroophthalmologist and the management strategy that depends on the clinical manifestations, as well as the presence of co-morbidities. Prompt surgical decompression is initially indicated in cases with severe or progressive impairment of the visual acuity or the visual fields or with altered mental state and leads to visual and neurological recovery in most of the patients. The patients with mild, stable clinical picture (including those with isolated ocular palsies) can be managed conservatively (support of fluid and electrolyte balance and stress doses of steroids in most cases) with favourable visual and neurological outcome. Frequent reassessment is mandatory because the clinical course can be unpredictable; if progression of symptoms occurs, later elective surgery is indicated and is beneficial, especially in terms of visual outcome. The endocrinological outcome is less favourable, irrespective of the treatment option, with many patients remaining on long-term replacement therapy. Despite the above guidelines, clear proof of optimal outcomes in the form of randomised controlled trials is lacking. Regrowth of the pituitary tumour years after a PA episode is possible and patients require long-term surveillance.

show abstract

Sudden Death from Pituitary Apoplexy in a Patient Presenting with an Isolated Sixth Cranial Nerve Palsy

Cited by 35 publications

References 7 publications

Sudden adult death

Sudden adult death

Vasospasm and Cerebral Infarction from Pituitary Apoplexy

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

Contact Info

Product

Resources

About