Endoscopic Endonasal Transsphenoidal Resection of Pituitary Apoplexy: Assessment of Visual and Endocrine Outcomes

Abstract Purpose Headache is common among patients with pituitary adenomas undergone endoscopic endonasal surgery (EES), but was seldomly concerned before. The present study aims to investigate the incidence and profile of risk factors of headache after EES.Methods A meta-analysis was performed to evaluate the occurrence proportions of postoperative headache in patients with pituitary adenomas. Then, a cohort of 101 patients undergone EES were enrolled for analyzing risk factors of headache. The Headache Impact Test (HIT-6) was used to score the headache preoperatively, 1 month and 3 months postoperatively. Results A total of 18 studies and 4442 participants were included for meta-analysis. The pooled occurrence proportion of postoperative headache was 29% (95% confidential interval: 20-38%). For the 101 patients enrolled in the present study, 26 (25.74%) of them had a HIT-6 scores of > 55 preoperatively, but decreased to 22 (21.78%) at 1 month, and 6 (5.94%) at 3 months, postoperatively. Multivariate analysis showed that pituitary apoplexy (OR=3.591, 95%CI 1.219-10.575, p=0.020) and Hardy's grade C-D (OR=21.06, 95%CI 2.25-197.02, p=0.008) were independently risk factors for preoperative headache. In contrast, postoperative sinusitis (OR=3.88, 95%CI 1.16-13.03, P=0.028) and Hardy's grade C-D (OR=10.53, 95%CI 1.02-109.19, P=0.049) independently predicted the presence of postoperative headache at 1 month. At 3 months postoperatively, the proportion of sinusitis tended to be higher in the headache group than the one in non-headache group (100% vs. 30.0%, p=0.070). Conclusion Headache is very common following EES for pituitary adenomas. Prophylactic management of postoperative sinusitis may help to alleviate postoperative headache.

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Endoscopic Endonasal Transsphenoidal Resection for Pituitary Apoplexy during the Third Trimester of Pregnancy

Surgery Research and Practice ◽

10.1155/2014/397131 ◽

2014 ◽

Vol 2014 ◽

pp. 1-4 ◽

Cited By ~ 2

Author(s):

Adesh Tandon ◽

Juan Alzate ◽

Patrick LaSala ◽

Marvin P. Fried

Keyword(s):

Vision Loss ◽

Pituitary Apoplexy ◽

Sella Turcica ◽

Third Trimester ◽

Endoscopic Endonasal ◽

Acute Hemorrhage ◽

The Third ◽

Vascular Insufficiency ◽

The Brain ◽

Transsphenoidal Resection

Pituitary apoplexy is an uncommon phenomenon typically characterized by vascular insufficiency or acute hemorrhage into a pituitary adenoma. The overall incidence of pituitary apoplexy ranges between 1 and 25% of all pituitary adenomas. With the widespread use of MRI technology, the diagnosis of asymptomatic intratumoral hemorrhage is closer to 10%. The authors report a case of a 27-year-old female in her 36th week of pregnancy who presented with severe onset headache and acute left-sided vision loss. MRI of the brain revealed a large hemorrhagic mass occupying the sella turcica. The patient underwent an emergent endoscopic endonasal transsphenoidal resection for pituitary apoplexy. Postoperatively, the patient’s neurologic deficit resolved. Minimally invasive endoscopic endonasal transsphenoidal resection of pituitary apoplexy can be safely utilized in third trimester pregnant women presenting with acute severe neurologic deficits.

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Endoscopic Endonasal Transtuberculum Transplanum Approach for Resection of Giant Pituitary Adenoma: The Second Floor Strategy to Avoid Postoperative Pituitary Apoplexy

10.1055/s-0040-1702625 ◽

2020 ◽

Author(s):

Dante L. Pezzutti ◽

Daniel M. Prevedello

Keyword(s):

Pituitary Adenoma ◽

Pituitary Apoplexy ◽

Endoscopic Endonasal ◽

Giant Pituitary Adenoma

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Coronavirus disease 2019 infection and pituitary apoplexy: A causal relation or just a coincidence? A case report and review of the literature

Surgical Neurology International ◽

10.25259/sni_401_2021 ◽

2021 ◽

Vol 12 ◽

pp. 317

Author(s):

Walaa A. Kamel ◽

Mustafa Najibullah ◽

Mamdouh S. Saleh ◽

Waleed A. Azab

Keyword(s):

Mr Imaging ◽

Causal Relation ◽

Histopathological Examination ◽

Case Reports ◽

English Literature ◽

Clinical Findings ◽

Oculomotor Nerve Palsy ◽

Future Research ◽

Endoscopic Endonasal ◽

Transsphenoidal Resection

Background: Pituitary tumor apoplexy (PA) is an emergency condition caused by hemorrhage or infarction of the preexisting adenoma. Many factors are currently well-known to predispose to PA. However, during the period of coronavirus disease 2019 (COVID-19) pandemic, case reports of PA associated with COVID-19 infection have been sequentially published. To the best of our knowledge, four cases have been reported so far in the English literature. We herein report the fifth case of this association and review the pertinent literature. Case Description: A 55-year-old male patient with confirmed COVID-19 infection presented by progressive decrease in visual acuity and oculomotor nerve palsy. His medical history is notable for diabetes mellitus, hypertension, and pituitary macroadenoma resection 11 years ago. He was on hormonal replacement therapy for panhypopituitarism that complicated the surgery. Previous magnetic resonance (MR) imaging studies were consistent with enlarging residual pituitary adenoma. During the current hospitalization, computed tomography revealed hyperdensity of the sellar and suprasellar areas. MR imaging revealed PA in a recurrent large adenoma. Endoscopic endonasal transsphenoidal resection was uneventfully undertaken with near total excision of the adenoma and partial improvement of visual loss and oculomotor palsy. Histopathological examination demonstrated classic features of PA. However, his chest condition progressed and he had to be transferred to COVID-19 intensive care unit in the referring hospital where he was intubated and put on mechanical ventilation. One week later, the patient unfortunately passed away due to complications of severe COVID-19 pneumonia. Conclusion: We report the fifth case of PA associated with COVID-19 infection. Based on our patient’s clinical findings, review of the other reported cases, as well as the available literature, we put forth a multitude of pathophysiological mechanisms induced by COVID-19 that can possibly lead to the development of PA. In our opinion, the association between both conditions is not just a mere coincidence. Although the histopathological features of PA associated with COVID-19 are similar to PA induced by other etiologies, future research may disclose unique pathological fingerprints of COVID-19 virus that explains its capability of inducing PA.

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Cushing's disease with pituitary apoplexy leading to hypopituitarism, empty sella, and spontaneous fracture of the dorsum sellae

Journal of Neurosurgery ◽

10.3171/jns.1979.51.6.0866 ◽

1979 ◽

Vol 51 (6) ◽

pp. 866-869 ◽

Cited By ~ 19

Author(s):

Philip H. Gutin ◽

William G. Cushard ◽

Charles B. Wilson

Keyword(s):

Pituitary Adenoma ◽

Cushing’S Disease ◽

Plasma Cortisol ◽

Pituitary Apoplexy ◽

Empty Sella ◽

Cushing's Disease ◽

Content Type ◽

Urinary Levels ◽

Fine Print ◽

Transsphenoidal Resection

✓ A patient with a pituitary adenoma secreting adrenocorticotropin hormone manifested panhypopituitarism after an episode of pituitary apoplexy. The previously elevated urinary levels of 17-ketogenic steroids dropped sharply, and plasma cortisol became undetectable. The apoplexy also resulted in a partially empty sella on which the dorsum sellae collapsed. Recurrent Cushing's disease developed and was cured by transsphenoidal resection of a microadenoma.

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Delayed Postoperative Pituitary Apoplexy after Endoscopic Transsphenoidal Resection of a Giant Pituitary Macroadenoma

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0032-1312303 ◽

2012 ◽

Vol 73 (S 01) ◽

Author(s):

Smruti Patel ◽

Lana Christiano ◽

Jean Eloy ◽

James Liu

Keyword(s):

Pituitary Apoplexy ◽

Pituitary Macroadenoma ◽

Transsphenoidal Resection

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Corrigendum to “In Reply to the Letter to the Editor Regarding “Endoscopic Endonasal Surgery for Pituitary Apoplexy: Evidence On a 75 Case-Series From a Tertiary Care Center”” [World Neurosurgery 109 (2018) 502]

World Neurosurgery ◽

10.1016/j.wneu.2018.01.152 ◽

2018 ◽

Vol 112 ◽

pp. 328

Author(s):

Matteo Zoli ◽

Laura Milanese ◽

Marco Faustini-Fustini ◽

Federica Guaraldi ◽

Sofia Asioli ◽

...

Keyword(s):

Pituitary Apoplexy ◽

Care Center ◽

Tertiary Care ◽

Case Series ◽

Tertiary Care Center ◽

Endoscopic Endonasal Surgery ◽

Endonasal Surgery ◽

Endoscopic Endonasal ◽

Letter To The Editor

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Postoperative GH and Degree of Reduction in IGF-1 Predicts Postoperative Hormonal Remission in Acromegaly

Frontiers in Endocrinology ◽

10.3389/fendo.2021.743052 ◽

2021 ◽

Vol 12 ◽

Author(s):

Tyler Cardinal ◽

Casey Collet ◽

Michelle Wedemeyer ◽

Peter A. Singer ◽

Martin Weiss ◽

...

Keyword(s):

Pituitary Adenomas ◽

Roc Curves ◽

Subtotal Resection ◽

Excessive Sweating ◽

Endoscopic Endonasal ◽

Cavernous Sinus Invasion ◽

Postoperative Mri ◽

Transsphenoidal Resection

PurposeDetermine predictive factors for long-term remission of acromegaly after transsphenoidal resection of growth hormone (GH)-secreting pituitary adenomas.MethodsWe identified 94 patients who had undergone transsphenoidal resection of GH-secreting pituitary adenomas for treatment of acromegaly at the USC Pituitary Center from 1999-2019 to determine the predictive value of postoperative endocrine lab values.ResultsPatients underwent direct endoscopic endonasal (60%), microscopic transsphenoidal (38%), and extended endoscopic approaches (2%). The cohort was 63% female and 37% male, with average age of 48.9 years. Patients presented with acral enlargement (72, 77%), macroglossia (40, 43%), excessive sweating (39, 42%), prognathism (38, 40%) and frontal bossing (35, 37%). Seventy-five (80%) were macroadenomas and 19 (20%) were microadenomas. Cavernous sinus invasion was present in 45%. Available immunohistochemical data demonstrated GH staining in 88 (94%) and prolactin in 44 (47%). Available postoperative MRI demonstrated gross total resection in 63% of patients and subtotal resection in 37%. Most patients (66%) exhibited hormonal remission at 12 weeks postoperatively. Receiver operating characteristic (ROC) curves demonstrated postoperative day 1 (POD1) GH levels ≥1.55ng/mL predicted failure to remit from surgical resection alone (59% specificity, 75% sensitivity). A second ROC curve showed decrease in corrected insulin-like growth factor-1 (IGF-1) levels of at least 37% prognosticated biochemical control (90% sensitivity, 80% specificity).ConclusionPOD1 GH and short-term postoperative IGF-1 levels can be used to successfully predict immediate and long-term hormonal remission respectively. A POD1 GH cutoff can identify patients likely to require adjuvant therapy to emphasize clinical follow-up.

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