scholarly journals 41‐year‐old male with a pituitary mass

2021 ◽  
Author(s):  
Wenjuan Wen ◽  
Leiming Wang ◽  
Mengyou Li ◽  
Peijin Li ◽  
Yubo Ren ◽  
...  
Keyword(s):  
Pituitary Mass

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

2015 ◽  
Vol 172 (5) ◽  
pp. R179-R190 ◽  
Author(s):  
Cristina Capatina ◽  
Warrick Inder ◽  
Niki Karavitaki ◽  
John A H Wass
Keyword(s):  
Elective Surgery ◽  
Visual Fields ◽  
Clinical Manifestations ◽  
Pituitary Tumour ◽  
Clinical Syndrome ◽  
Electrolyte Balance ◽  
Pituitary Mass ◽  
Optimal Care ◽  
Wide Range

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.

Pitfalls of a Pituitary Mass Presentation — A Rare Form of Metastatic Thyroid Carcinoma

2011 ◽  
pp. P3-639-P3-639
Author(s):  
Claudia Silva Liboni ◽  
Martha Lenardt Sulzbach ◽  
Joao Roberto de Sa ◽  
Ana Maria Lengyel ◽  
Maciel Rui Monteiro de Barros ◽  
...  
Keyword(s):  
Thyroid Carcinoma ◽  
Rare Form ◽  
Pituitary Mass

scholarly journals Nelson's Syndrome

2007 ◽  
Vol 51 (8) ◽  
pp. 1392-1396 ◽  
Author(s):  
Alia Munir ◽  
John Newell-Price
Keyword(s):  
Cushing’S Disease ◽  
Pituitary Tumour ◽  
Bilateral Adrenalectomy ◽  
Cushing's Disease ◽  
Treatment Modalities ◽  
Pituitary Mass ◽  
Nelson’S Syndrome ◽  
Nelson's Syndrome ◽  
Great Heterogeneity ◽  
The One

Nelson's syndrome is a potentially severe complication of bilateral adrenalectomy performed in the treatment of Cushing's disease, and its management remains difficult. Of all of the features of Nelson's syndrome, the one that causes most concern is the development of a locally aggressive pituitary tumour, which, unusually for pituitary disease, may occasionally cause death from the tumour itself. This feature is especially pertinent given the increasing use in Cushing's disease of laparoscopic bilateral adrenal surgery as a highly effective treatment modality to control cortisol-excess. Despite numerous studies and reports, there is no formal consensus of what defines Nelson's syndrome. Thus, some will define Nelson's syndrome according to the classical description with an evolving pituitary mass after bilateral adrenalectomy, whereas others will rely on increasing plasma ACTH levels, even in the absence of a clear pituitary mass lesion on MRI. These factors need to be borne in mind when considering the reports of Nelson's syndrome, as there is great heterogeneity, and it is likely that overall the modern 'Nelson's syndrome' represents a different disease entity from that of the last century. In the present paper, clinical and epidemiological features of Nelson's syndrome, as well as its treatment modalities, are reviewed.

scholarly journals DIAGNOSIS OF ENDOCRINE DISEASE: Diagnostic approach to TSH-producing pituitary adenoma

2017 ◽  
Vol 177 (4) ◽  
pp. R183-R197 ◽  
Author(s):  
Axel Tjörnstrand ◽  
Helena Filipsson Nyström
Keyword(s):  
Rare Condition ◽  
Diagnostic Approach ◽  
Laboratory Assessment ◽  
Pituitary Mass ◽  
Endocrine Disease ◽  
Clinical Presentations ◽  
Practical Suggestion ◽  
Tsh Secretion ◽  
Diagnostic Approaches ◽  
Inappropriate Tsh Secretion

Thyrotropin (TSH)-secreting adenomas (TSHomas) are the rarest form of pituitary adenomas, and most endocrinologists will see few cases in a lifetime, if any. In most cases, the diagnostic approach is complicated and cases may be referred after being presented as a syndrome of inappropriate TSH secretion or as a pituitary mass. This review aims to cover the past, present and possible future diagnostic approaches to TSHomas, including different clinical presentations, laboratory assessment and imaging advances. The differential diagnoses will be discussed, as well as possible coexisting disorders. By evaluating the existing reports and reviews describing this rare condition, this review aims to present a clinically practical suggestion on the diagnosic workup for TSHomas, Major advances and scientific breakthroughs in the imaging area in recent years, facilitating diagnosis of TSHomas, support the belief that future progress within the imaging field will play an important role in providing methods for a more efficient diagnosis of this rare condition.

Assessing Risk of Severe Complications after Endoscopic Transnasal Transsphenoidal Surgery: A Comparison of Frailty, American Society of Anesthesiologists, and Comorbidity Scores

2021 ◽  
Author(s):  
Jordan M. Sukys ◽  
Roy Jiang ◽  
Richard P. Manes
Keyword(s):  
Frailty Index ◽  
Information Criteria ◽  
Improvement Program ◽  
Pituitary Mass ◽  
Complication Risk ◽  
Comorbidity Scores ◽  
Multivariable Regression ◽  
American Society ◽  
Akaike’S Information Criteria ◽  
American Society Of Anesthesiologists

Abstract Objective This study aimed to improve age-independent risk stratification for patients undergoing endoscopic transnasal transsphenoidal (TNTS) approach to pituitary mass resection by investigating the associations between frailty, American Society of Anesthesiologists (ASA), and comorbidity scores with severe complications following TNTS. Design This study is a retrospective review. Setting This review was conducted utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database. Participants A total of 680 cases of TNTS identified from 2010 to 2013 were included in this study. Main Outcome Measures The modified frailty index (mFI) was calculated to quantify frailty. ASA and Charlson's comorbidity index (CCI) scores were obtained as physiologic status and comorbidity-based prognostic markers. Severe complications were separated into intensive care unit (ICU)-level complications, defined by Clavien–Dindo grade IV (CDIV) criteria, and mortality. Results Overall, 24 CDIV complications (3.5%) and 6 deaths (0.9%) were recorded. Scores for mFI (p = 0.01, R 2 = 0.97) and ASA (p = 0.04., R 2 = 0.87) were significantly correlated with CDIV complications. ASA scores were significantly correlated with mortality (p = 0.03, R 2 = 0.87), as well as independently associated with CDIV complication by multivariable regression models (odds ratio [OR] = 2.96, 95% confidence interval [CI]: 1.35–6.83, p < 0.01), while mFI was not. CCI was not significantly associated with CDIV complications or mortality. A multivariable regression model incorporating ASA had a lower Akaike's Information Criteria (AIC; 188.55) than a model incorporating mFI (195.99). Conclusion Frailty and physiologic status, as measured by mFI and ASA scores respectively, both correlate with ICU-level complications after TNTS. ASA scores demonstrate greater clinical utility than mFI scores; however, as they are more easily generated, uniquely correlated with mortality and independently associated with ICU-level complication risk on multivariable regression analysis.

Pituitary incidentalomas

2011 ◽  
pp. 229-232
Author(s):  
Niki Karavitaki
Keyword(s):  
Pituitary Mass ◽  
Pituitary Incidentaloma

A pituitary incidentaloma is defined strictly as a ‘totally asymptomatic nonfunctional tumour, clinically and biochemically silent, which was discovered incidentally on a patient who is asymptomatic’ or, less strictly, a pituitary mass discovered in the course of evaluation for an unrelated problem (1, 2). Based on the second definition, the term incidentaloma may not be appropriate to many of these lesions, as an incidentally detected macroadenoma may still be clinically relevant.

scholarly journals Rituximab treatment for isolated IgG4-related hypophysitis in a teenage female

2018 ◽  
Vol 2018 ◽  
Author(s):  
Danielle R Bullock ◽  
Bradley S Miller ◽  
H Brent Clark ◽  
Patricia M Hobday
Keyword(s):  
Endocrine Function ◽  
List Type ◽  
Pituitary Mass ◽  
Related Disease ◽  
Pituitary Dysfunction ◽  
Igg4 Related Disease ◽  
Pituitary Disease ◽  
Appropriate Treatment ◽  
Organ Systems ◽  
Progression Of Disease

Summary IgG4-related hypophysitis is an important diagnostic consideration in patients with a pituitary mass or pituitary dysfunction and can initially present with headaches, visual field deficits and/or endocrine dysfunction. Isolated IgG4-related pituitary disease is rare, with most cases of IgG4-related disease involving additional organ systems. We report the case of a teenage female patient with isolated IgG4-related hypophysitis, diagnosed after initially presenting with headaches. Our patient had no presenting endocrinologic abnormalities. She was treated with surgical resection, prednisolone and rituximab with no further progression of disease and sustained normal endocrine function. This case, the youngest described patient with isolated IgG4-related hypophysitis and uniquely lacking endocrinologic abnormalities, adds to the limited reports of isolated pituitary disease. The use of rituximab for isolated pituitary disease has never been described. While IgG4-related hypophysitis has been increasingly recognized, substantial evidence concerning the appropriate treatment and follow-up of these patients is largely lacking. Learning points: IgG4-related hypophysitis most often occurs in the setting of additional organ involvement but can be an isolated finding. This diagnosis should therefore be considered in a patient presenting with pituitary abnormalities. Most patients with IgG4-related hypophysitis will have abnormal pituitary function, but normal functioning does not exclude this diagnosis. Corticosteroids have been the mainstay of therapy for IgG4-related disease, with other immunosuppressive regimens being reserved for refractory cases. Further research is needed to understand the effectiveness of corticosteroid-sparing regimens and whether there is utility in using these agents as first-line therapies.

scholarly journals Heparin-Induced Pituitary Apoplexy Presenting as Isolated Unilateral Oculomotor Nerve Palsy: A Case Report and Literature Review

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Bakr Swaid ◽  
Frank Kalaba ◽  
Ghassan Bachuwa ◽  
Stephen E. Sullivan
Keyword(s):  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Significant Coronary Artery Disease ◽  
Clinical Syndrome ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Visual Field Defects ◽  
Pituitary Mass ◽  
Atypical Chest Pain ◽  
Coronary Syndrome

Introduction. Pituitary apoplexy (PA) is a rare and potentially life-threatening clinical syndrome resulting from pituitary gland hemorrhage and/or infarction. Anticoagulation is a risk factor for triggering PA. Isolated oculomotor nerve palsy is an atypical presentation of PA. Case Presentation. A 65-year-old African American female with no past medical history of pituitary disease presented to the emergency department (ED) with nonspecific abdominal pain that was thought to be secondary to fecal stasis and subsequently improved with laxatives. She also reported atypical chest pain that was concerning for unstable angina. She was started on aspirin, clopidogrel, and intravenous (IV) heparin. Later, coronary catheterization showed no significant coronary artery disease (CAD). Twelve hours after the procedure, the patient developed acute complete left oculomotor nerve palsy with a severe headache. Magnetic resonance imaging (MRI) of the head showed a large pituitary mass. Pituitary apoplexy was suspected and the patient eventually underwent a successful trans-sphenoidal pituitary resection. Discussion. We report a case of PA manifesting as isolated left oculomotor nerve palsy without visual field defects in the setting of using dual antiplatelet therapy (DAPT) and IV heparin for acute coronary syndrome. To the best of our knowledge, this unique combination has not been previously reported.

Diagnosis and management of pituitary abscess: a review of twenty-four cases

2001 ◽  
Vol 95 (2) ◽  
pp. 233-241 ◽  
Author(s):  
G. Edward Vates ◽  
Mitchel S. Berger ◽  
Charles B. Wilson
Keyword(s):  
San Francisco ◽  
Hormone Replacement ◽  
Sella Turcica ◽  
Signs And Symptoms ◽  
Cystic Mass ◽  
Pituitary Abscess ◽  
Pituitary Mass ◽  
Content Type ◽  
Visual Changes ◽  
Fine Print

Object. Pituitary abscess is a rare but serious intrasellar infection. To better determine the salient signs and symptoms that help in making the diagnosis, and to determine the most appropriate treatment, the authors reviewed their experience in a series of 24 patients treated at the University of California at San Francisco. Methods. Nine of the patients were female and 15 were male, and their mean age was 41.2 years (range 12–71 years). Surprisingly, most patients in our series presented with complaints and physical findings consistent with a pituitary mass, but rarely with evidence of a serious infection. Headache, endocrine abnormalities, and visual changes were the most common clinical indicators; fever, peripheral leukocytosis, and meningismus were present in 33% or fewer of the patients. Imaging tests demonstrated a pituitary mass in all patients, but the features evident on computerized tomography and magnetic resonance studies did not distinguish pituitary abscesses from other, more common intrasellar lesions. Because of the ambiguous clinical features and imaging findings, most abscesses were not diagnosed before treatment; rather, the diagnosis was made during surgical exploration of the sella turcica, when the surgeon encountered a cystic mass containing pus. There were only two deaths in this series (8.3%). Patients presenting with headache and visual changes noted improvement in almost all cases; patients with endocrine dysfunction generally did not recover normal pituitary function, but were easily treated with hormone replacement therapy. Conclusions. Antibiotic therapy is suggested for patients who have symptoms of sepsis, or for patients in whom specific organisms are identified from cultures obtained during surgery. The transsphenoidal approach is recommended over open craniotomy for surgical drainage.

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