Acute Headache in Pregnancy

2017 ◽  
Author(s):  
M. Angela O’Neal
Keyword(s):  
Growth Hormone ◽  
Adrenocorticotropic Hormone ◽  
Pituitary Apoplexy ◽  
Optic Chiasm ◽  
Visual Disturbance ◽  
Electrolyte Imbalance ◽  
Clinical Feature ◽  
Acute Headache ◽  
Optic Nerve Involvement ◽  
In Pregnancy

The case illustrates the characteristics of pituitary apoplexy. This anatomy of the pituitary, which predisposes to the condition, is described. The most common clinical feature is headache. Visual disturbance related to optic chiasm or optic nerve involvement is also common. Pituitary apoplexy is a neuroendocrine emergency. The most important hormone involved is adrenocorticotropic hormone, ACTH. However, there are often multiple hormonal deficiencies: growth hormone, hypothyroidism, and hypogonadotropic deficiency. A high prolactin level may reflect a prolactinoma or be due to hypothalamic inhibition. Diabetes insipidus (DI) is also common. The most urgent issue in treating pituitary apoplexy is prompt assessment of fluid and electrolyte imbalance and the replacement of corticosteroids.

scholarly journals Visual disturbance as primary symptom of pituitary apoplexy in pregnancy

2021 ◽  
Vol 3 (4) ◽  
pp. 244-249
Author(s):  
Norazlida Ibrahim ◽  
Raja Norliza Binti Raja Omar ◽  
Mae-Lynn Catherine Bastion
Keyword(s):  
Visual Field ◽  
Pituitary Apoplexy ◽  
Wide Spectrum ◽  
Brain Mri ◽  
Visual Field Loss ◽  
Optic Chiasm ◽  
Visual Disturbance ◽  
Mortality And Morbidity ◽  
Pituitary Lesion ◽  
In Pregnancy

Pituitary apoplexy in pregnancy is a potentially fatal condition caused by acute ischaemic infarction or haemorrhage of pre-existing pituitary adenoma or within a physiologically enlarged pituitary gland. It has a wide spectrum of clinical presentations ranging from a mild headache to sudden collapsed. Here, we report a life-threatening case of pituitary apoplexy in a non-functioning pituitary macroadenoma occurring during pregnancy that presented with bilateral blurring of vision. Visual field showed bitemporal superior quadrantanopia. Urgent non-contrast brain MRI revealed an acute expansion of a hemorrhagic pituitary lesion complicated with local compression to the optic chiasm. The patient underwent an uneventful right supraorbital craniotomy and excision of the tumour under general anaesthesia with no foetal loss. The repeated visual field at 2 weeks after surgery showed recovering visual field defect. Hence, early neurosurgical intervention is advisable to prevent mortality and morbidity due to permanent visual field loss.

scholarly journals A case of pituitary apoplexy in pregnancy

2014 ◽  
Vol 2014 ◽  
Author(s):  
Aimee R Hayes ◽  
Anthony J O'Sullivan ◽  
Mark A Davies
Keyword(s):  
Pituitary Apoplexy ◽  
Rare Event ◽  
Visual Disturbance ◽  
List Type ◽  
The Subject ◽  
Magnetic Resonance Imaging Mri ◽  
Evidence Of Impact ◽  
Learning Points ◽  
Visual Abnormalities ◽  
In Pregnancy

Summary Pituitary apoplexy is a rare event in pregnancy. A 41-year-old woman with a known pituitary microadenoma presented with visual disturbance and headache during the second trimester of pregnancy. Magnetic resonance imaging (MRI) demonstrated pituitary apoplexy with chiasmal compression. After treatment with corticosteroid therapy, she underwent transsphenoidal excision of the pituitary adenoma. Visual abnormalities were completely restored and pituitary function preserved. There was no evidence of impact on the foetus. The literature on the subject is reviewed with emphasis on the management of the apoplectic patient with mild and stable neuro-ophthalmological signs. Learning points There are no clear guidelines on the management of pituitary apoplexy in pregnancy. A multidisciplinary approach can minimise morbidity and mortality. Pituitary apoplexy has an unpredictable clinical course and determining which clinical situations warrant early surgery needs to take into consideration the presence and severity of neurological signs and their stability. The management of conscious apoplectic patients with absent or mild and stable neuro-ophthalmological signs is controversial.

scholarly journals SAT-273 Case of Mistaken Identity?

2020 ◽  
Vol 4 (Supplement_1) ◽  
Author(s):  
Carlos Pla
Keyword(s):  
Muscle Weakness ◽  
Pituitary Adenomas ◽  
Complete Resolution ◽  
Pituitary Apoplexy ◽  
Optic Chiasm ◽  
Visual Disturbance ◽  
Pituitary Macroadenoma ◽  
Patient Reported ◽  
Work Up

Abstract Introduction Pituitary adenomas occur in 10-15% of patients and the majority are benign. Prolactinomas are the most common form of secretory pituitary adenoma. Pituitary apoplexy, a medical emergency with resulting visual loss and hormonal hyposecretion, requires rapid surgical intervention. We present a case of pituitary macroadenoma that underwent pituitary resection for acute visual disturbance which was later discovered to be caused by undiagnosed demyelinating disease. Clinical Case Patient is a 32-year-old male who presented initially with complain of fatigue and decreased libido. Work up revealed elevated prolactin level and low testosterone. MRI showed a 2x3cm pituitary macroadenoma. At moment of diagnosis, patient was otherwise asymptomatic. He was started on bromocriptine. During follow up visits, patient reported visual disturbance. First MRI in our clinic showed no suprasellar extension, no impingement of optic chiasm and nonspecific white matter disease. At that time, visual field testing showed left temporal defect in superior quadrant. Follow up MRI 1 year later continued to show a stable macroadenoma without impingement of the optic chiasm, but patient reported progressive left vision disturbance and new right vision loss. He was evaluated in the emergency room where he was treated for pituitary apoplexy with steroids and surgery. Vision improved the next day. Despite uncomplicated post-operative course, patient developed proximal muscle weakness and exam notable for diffuse motor deficit in bilateral lower extremities with hyperreflexia. Endocrinology workup was negative for hypercortisolism and ophthalmology diagnosed him with optic neuropathy. Neurology evaluation led to a diagnosis of multiple sclerosis (MS). Patient was started on natalizumab with complete resolution of all visual and muscle symptoms. Clinical lesson Our patient presented with complaints of fatigue, decreased libido and work up that showed a macroprolactinoma without MRI evidence of optic chiasm impingement. During treatment, he developed acute visual deficits that were attributed to pituitary apoplexy. This visual disturbance improved after surgery and use of high dose IV steroids, with the latter likely treating what had been an MS flare. In hindsight, ophthalmologic evaluation before surgery had shown new color blindness, a sign of optic neuropathy. Despite temporary relief, patient progressed to develop new muscle weakness and recurrent visual disturbance which led to the diagnosis of MS. Since being diagnosed and treated for MS, he has had complete resolution of his symptoms. This case stresses the importance of considering other etiologies for visual defects in patients with pituitary adenomas.

scholarly journals Recurrent pituitary apoplexy in pregnancy

2021 ◽  
Vol 14 (8) ◽  
pp. e242353
Author(s):  
Franziska Geissler ◽  
Irene Hoesli ◽  
Monya Todesco Bernasconi
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Gland ◽  
Preterm Delivery ◽  
Pituitary Apoplexy ◽  
Signs And Symptoms ◽  
Visual Disturbance ◽  
Severe Headache ◽  
Altered Consciousness ◽  
Existing Data ◽  
In Pregnancy

Pituitary apoplexy is caused by haemorrhage or infarction of the pituitary gland. Presenting signs and symptoms often include severe headache, visual disturbance, ophthalmoplegia, altered consciousness and impaired pituitary function. The management of pituitary apoplexy has very rarely been described during pregnancy and there is no existing data for further pregnancies of affected women. We present a case of a woman with a recurrent pituitary apoplexy due to haemorrhages in a pituitary adenoma in her third and fourth pregnancies. In both pregnancies, the pituitary apoplexy was managed conservatively, but due to therapy-resistant headaches, a preterm delivery was implemented.

Prolactinoma causing visual disturbance in pregnancy - a multidisciplinary management conundrum

2019 ◽  
Author(s):  
Sultana Azam ◽  
Rebecca Scott ◽  
Chioma Izzi-Engbeaya ◽  
Sheba Jarvis ◽  
Suhaniya Samarasinghe ◽  
...  
Keyword(s):  
Visual Disturbance ◽  
Multidisciplinary Management ◽  
In Pregnancy

scholarly journals Treatment and therapeutic strategies for pituitary apoplexy in pregnancy: a case series

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Yuya Kato ◽  
Yoshikazu Ogawa ◽  
Teiji Tominaga
Keyword(s):  
Pituitary Apoplexy ◽  
Clinical Symptoms ◽  
Case Series ◽  
Optimal Timing ◽  
Presenting Symptoms ◽  
Pathological Evaluation ◽  
Mother And Child ◽  
Life Threatening ◽  
In Pregnancy

Abstract Background Pregnancy is a known risk factor for pituitary apoplexy, which is life threatening for both mother and child. However, very few clinical interventions have been proposed for managing pituitary apoplexy in pregnancy. Case presentation We describe the management of three cases of pituitary apoplexy during pregnancy and review available literature. Presenting symptoms in our case series were headache and/or visual disturbances, and the etiology in all cases was hemorrhage. Conservative therapy was followed until 34 weeks of gestation, after which babies were delivered by cesarean section with prophylactic bolus hydrocortisone supplementation. Tumor removal was only electively performed after delivery using the transsphenoidal approach. All three patients and their babies had a good clinical course, and postoperative pathological evaluation revealed that all tumors were functional and that they secreted prolactin. Conclusions Although the mechanism of pituitary apoplexy occurrence remains unknown, the most important treatment strategy for pituitary apoplexy in pregnancy remains adequate hydrocortisone supplementation and frequent hormonal investigation. Radiological follow-up should be performed only if clinical symptoms deteriorate, and optimal timing for surgical resection should be discussed by a multidisciplinary team that includes obstetricians and neonatologists.

scholarly journals Comparative analysis of anterior third ventricle approaches

2020 ◽  
pp. 544-549
Author(s):  
Deepak Kumar Singh ◽  
Kuldeep Yadav ◽  
Rakesh Kumar ◽  
Arun Kumar Singh ◽  
Vipin Kumar Chand
Keyword(s):  
Third Ventricle ◽  
Medical Science ◽  
Optic Chiasm ◽  
Visual Disturbance ◽  
Colloid Cyst ◽  
Subtotal Resection ◽  
Common Symptom ◽  
Anatomical Landmarks ◽  
Transcallosal Approach ◽  
Transforaminal Approach

Background. Third ventricle tumors are uncommon and account for only 0.6 - 0.9% of all the brain tumors7. In 1921, Dandy was the first neurosurgeon who successfully removed a colloid cyst from the third ventricle through a posterior transcallosal approach. Despite their unfavourable locations, these tumours can be removed successfully by proper knowledge of anatomical landmarks and by choosing the appropriate approach. Methods. We performed a retrospective analysis of all patients (17 patients) who underwent surgery for anterior third ventricular masses between March 2018 to March 2020 in the Dr Ram Manohar Lohia Institute of Medical Science Lucknow, Uttar Pradesh. Results: The most common symptom in our cases was headache, which was present in all (100%) patients, nausea/vomiting in 7 (41%), history of recurrent episodes of drop attacks in 4 (23%), h/o seizure in 2 (11.7%), visual disturbance in 1 (5.4%), memory disturbance in 1 (5.4%) and urinary incontinence in 1 (5.4%) patient. 6 patients were operated with transcallosal-transforaminal approach, 1 patient was operated with transcallosal interforniceal approach, 3 patients were operated with transcortical-transforaminal approach, 1 patient was operated with subfrontal translamina terminalis approach, 1 patient was operated with transcallosal-transchoroidal approach, 5 patients were operated with endoscopically. Gross total excision was achieved in 15 (88%) patients while in 2 (11.7%) patients subtotal resection was done due to their adherence to choroid plexus and optic chiasm. The most common post-operative complication was endocrine dysfunction in the form of diabetes insipidus. Conclusions. Anterior Third ventricular tumours are mostly benign and best treatment modality is surgical resection. When we analyzed the results of various approaches, we found that despite their unfavourable location, the results were satisfactory for different tumours of different location in the anterior third ventricle, when treated with the carefully planned microsurgical or endoscopic approach with proper knowledge of anatomical landmarks.

scholarly journals Endocrine Deficiency As a Function of Radiation Dose to the Hypothalamus and Pituitary in Pediatric and Young Adult Patients With Brain Tumors

2018 ◽  
Vol 36 (28) ◽  
pp. 2854-2862 ◽  
Author(s):  
Ralph E. Vatner ◽  
Andrzej Niemierko ◽  
Madhusmita Misra ◽  
Elizabeth A. Weyman ◽  
Claire P. Goebel ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Young Adults ◽  
Young Adult ◽  
Thyroid Hormone ◽  
Radiation Dose ◽  
Brain Tumors ◽  
Adrenocorticotropic Hormone ◽  
Hormone Deficiency ◽  
Children And Young Adults

Purpose There are sparse data defining the dose response of radiation therapy (RT) to the hypothalamus and pituitary in pediatric and young adult patients with brain tumors. We examined the correlation between RT dose to these structures and development of endocrine dysfunction in this population. Materials and Methods Dosimetric and clinical data were collected from children and young adults (< 26 years of age) with brain tumors treated with proton RT on three prospective studies (2003 to 2016). Deficiencies of growth hormone (GH), thyroid hormone, adrenocorticotropic hormone, and gonadotropins were determined clinically and serologically. Incidence of deficiency was estimated using the Kaplan-Meier method. Multivariate models were constructed accounting for radiation dose and age. Results Of 222 patients in the study, 189 were evaluable by actuarial analysis, with a median follow-up of 4.4 years (range, 0.1 to 13.3 years), with 31 patients (14%) excluded from actuarial analysis for having baseline hormone deficiency and two patients (0.9%) because of lack of follow-up. One hundred thirty patients (68.8%) with medulloblastoma were treated with craniospinal irradiation (CSI) and boost; most of the remaining patients (n = 56) received involved field RT, most commonly for ependymoma (13.8%; n = 26) and low-grade glioma (7.4%; n = 14). The 4-year actuarial rate of any hormone deficiency, growth hormone, thyroid hormone, adrenocorticotropic hormone, and gonadotropin deficiencies were 48.8%, 37.4%, 20.5%, 6.9%, and 4.1%, respectively. Age at start of RT, time interval since treatment, and median dose to the combined hypothalamus and pituitary were correlated with increased incidence of deficiency. Conclusion Median hypothalamic and pituitary radiation dose, younger age, and longer follow-up time were associated with increased rates of endocrinopathy in children and young adults treated with radiotherapy for brain tumors.

Tumor Tissue Identification in the Pseudocapsule of Pituitary Adenoma: Should the Pseudocapsule be Removed for Total Resection of Pituitary Adenoma?

2009 ◽  
Vol 64 (suppl_1) ◽  
pp. ONS62-ONS70 ◽  
Author(s):  
Eun Jig Lee ◽  
Jung Yong Ahn ◽  
Taewoong Noh ◽  
Se Hun Kim ◽  
Tai Seung Kim ◽  
...  
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Recurrence Rate ◽  
Adrenocorticotropic Hormone ◽  
Tumor Tissue ◽  
Remission Rate ◽  
Pituitary Function ◽  
Subtotal Resection ◽  
Total Resection ◽  
Resection Group

Abstract Objective: The microsurgical pseudocapsule can be found in the transition zone between an adenoma and the surrounding normal pituitary tissue. We investigated the precise histology of the pseudocapsule. Furthermore, we evaluated the remission rate, the changes in pituitary function, and the recurrence rate after intensive resection of the pseudocapsule. Methods: In 616 patients with pituitary adenomas (Hardy Types I–III) over a period of 14 years, we introduced intensive resection of the microsurgical pseudocapsule to achieve complete tumor removal. A combined pituitary function test and radiological study were performed on the patients before surgery, 1 year after surgery, and at subsequent 1.5-year intervals 2 to 13 years postoperatively. Results: Microsurgical pseudocapsules were identified in 343 (55.7%) of 616 patients, and the distinct microsurgical pseudocapsules were observed in 180 (52.5%) of these patients. In the remaining 163 patients, the microsurgical pseudocapsules were incompletely developed. Tumor cluster infiltration was present in the pseudocapsule in 71 (43.6%) of these patients. Aggressive resection of the microsurgical pseudocapsule was more often required in larger tumors than in smaller ones. The presence of a pseudocapsule was slightly more frequent in prolactin-secreting tumors (70.9%) than in growth hormone-secreting (55.0%) and adrenocorticotropic hormone-secreting (40.0%) tumors. In the 243 patients of the total resection group who underwent combined pituitary function tests more than 2 times after surgery, the surgical remission rate was 99.1 % in clinically nonfunctional tumors, 88% in growth hormone-secreting, 70.6% in prolactin-secreting, and 100% in adrenocorticotropic hormone-secreting tumors. The surgical remission rate was 86.2% in the presence of a pseudocapsule and 94.3% in the absence of a pseudocapsule. Preoperative hypopituitarism improved in 140 patients (57.6%), persisted in 47 patients (19.3%), and was aggravated in 33 patients (13.6%). There was no statistical difference in improvement or deterioration of pituitary function according to the existence or absence of the pseudocapsule. The tumor recurrence rate was 0.8% in the total resection group and was 42.1 % in the subtotal resection group. Conclusion: We have shown that tumor tissue is frequently present within the pseudocapsule, suggesting that any tumor remnant in the pseudocapsule could be a source of recurrence and an obstacle to achieving complete remission. These results indicate that intensive resection of the pseudocapsule could result in a higher remission rate without deteriorating pituitary function.

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