scholarly journals Multidisciplinary Management of Pituitary Apoplexy

2016 ◽  
Vol 2016 ◽  
pp. 1-11 ◽  
Author(s):  
Adriana Albani ◽  
Francesco Ferraù ◽  
Filippo Flavio Angileri ◽  
Felice Esposito ◽  
Francesca Granata ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Pituitary Gland ◽  
Multidisciplinary Approach ◽  
Pituitary Apoplexy ◽  
Clinical Syndrome ◽  
Surgical Decompression ◽  
Medical Emergency ◽  
Multidisciplinary Management ◽  
Pituitary Tumours ◽  
Haemorrhagic Necrosis

Pituitary apoplexy is a rare clinical syndrome due to ischemic or haemorrhagic necrosis of the pituitary gland which complicates 2–12% of pituitary tumours, especially nonfunctioning adenomas. In many cases, it results in severe neurological, ophthalmological, and endocrinological consequences and may require prompt surgical decompression. Pituitary apoplexy represents a rare medical emergency that necessitates a multidisciplinary approach. Modalities of treatment and times of intervention are still largely debated. Therefore, the management of patients with pituitary apoplexy is often empirically individualized and clinical outcome is inevitably related to the multidisciplinary team’s skills and experience. This review aims to highlight the importance of a multidisciplinary approach in the management of pituitary apoplexy and to discuss modalities of presentation, treatment, and times of intervention.

Pituitary tumours

2017 ◽  
Author(s):  
Edward R. Laws ◽  
Whitney W. Woodmansee ◽  
Jay S. Loeffler
Keyword(s):  
Radiation Therapy ◽  
Surgical Management ◽  
Visual Loss ◽  
Multidisciplinary Approach ◽  
Pituitary Hormones ◽  
Laboratory Evaluation ◽  
Multidisciplinary Management ◽  
Effective Solution ◽  
Benign Lesions ◽  
Pituitary Tumours

Pituitary tumours are common, usually benign, lesions ordinarily well controlled by multidisciplinary management. The several subtypes of pituitary tumours reflect the hormones produced by the pituitary gland, and each may require a complex sequential programme of treatment. Modern laboratory evaluation and imaging is capable of extensively characterizing the tumours, and is the basis for the recommended therapies. The tumours that produce excess active levels of pituitary hormones may be amenable to very satisfactory medical therapy, which reduces hormone levels towards normal, and often causes shrinkage of the tumour. Surgical management is appropriate for tumours that are not producing excess hormones but by nature of their bulk can compress the optic nerves and cause visual loss. These tumours respond well to surgical management, which is usually done using the transnasal, transsphenoidal route of access. Patients with persistent or recurrent tumours and persistent hormonal excess can be effectively treated with modern techniques of radiation therapy. A multidisciplinary approach with specialists from different fields concentrating on the patient and the problem offers a comprehensive and effective solution for most patients with pituitary disorders.

scholarly journals Hyponatremia as the Initial Presentation of Evolving Pituitary Apoplexy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A586-A586
Author(s):  
Jovan Milosavljevic ◽  
Asha Mary Thomas
Keyword(s):  
Mental Status ◽  
Pituitary Apoplexy ◽  
Pituitary Tumors ◽  
Altered Mental Status ◽  
Clinical Syndrome ◽  
Medical Emergency ◽  
Fluid Restriction ◽  
Free T4 ◽  
Acute Hemorrhage ◽  
Initial Testing

Abstract Pituitary apoplexy (PA) is a known, often under-recognized medical emergency and is characterized by ischemic or hemorrhagic necrosis of the pituitary gland. It is a rare clinical syndrome that occurs in 2-12% of pituitary tumors. Hyponatremia can occur secondary to hypocortisolism (12-40%) or, rarely, to the syndrome inappropriate antidiuretic hormone (ADH) secretion. We present the case of a 69-year-old man who presented with altered mental status on post-operative day 3 from total knee replacement surgery. Initial testing revealed hyponatremia of 124 mmol/L, low serum osmolality of 266 mOsm/kg, and high urine osmolality of 664 mOsm/kg with urine sodium of 179 mmol/L. Head computerized tomography revealed a sellar mass of 1.8 x 2.4 cm. Initial testing revealed low prolactin (0.7 ng/mL), normal TSH (0.458 mcIU/mL) with borderline low free T4 of 0.72 ng/dL. Morning cortisol was 12.7 mcg/dL with ACTH of 8.5 pg/mL. Cosyntropin stimulation test was done revealing baseline cortisol of 5.8 mcg/dL (at midnight), increasing to 25.8 mcg/dL after 30 minutes and to 30.9 mcg/dL 60 minutes after cosyntropin administration. His sodium and mental status initially improved with fluid restriction and salt tablets, for the assumed syndrome of inappropriate ADH secretion. The patient remained hemodynamically stable. On the fourth day, however, his mental status deteriorated. Magnetic resonance imaging revealed expansion of sella with hyperintense mass 2.2 x 2.0 x 2.8 cm with compression of the optic chiasm. He was given stress dose hydrocortisone and levothyroxine and underwent emergency transsphenoidal resection. Biopsy revealed acute hemorrhage within infarcted adenoma. Postoperatively, both the patient’s sodium and mental status improved significantly and he was discharged to home on hydrocortisone and levothyroxine. The main clinical concern in the management of PA remains under-diagnosis at presentation. Prognosis is dependent on management during the acute phase. PA can present as hyponatremia even in the absence of overt hypocortisolism, presumably due to inappropriate ADH secretion. Therefore, PA should be considered as one of the differential diagnoses in hemodynamically stable patients with altered mental status and hyponatremia.

Presenting Symptoms of Pituitary Apoplexy

2017 ◽  
Vol 79 (01) ◽  
pp. 052-059 ◽  
Author(s):  
Ioannis Mavridis ◽  
Maria Meliou ◽  
Efstratios-Stylianos Pyrgelis
Keyword(s):  
Pituitary Apoplexy ◽  
Sella Turcica ◽  
Abrupt Onset ◽  
Sudden Onset ◽  
Clinical Syndrome ◽  
Medical Emergency ◽  
Sudden Expansion ◽  
Visual Field Defects ◽  
Imaging Method ◽  
Presenting Symptoms

AbstractThe classical term “pituitary apoplexy” (PA) describes a clinical syndrome usually characterized by abrupt onset of headache accompanied by neurologic and/or endocrinologic deterioration due to sudden expansion of a mass within the sella turcica as a result of hemorrhage or infarction within a pituitary tumor and adjacent pituitary gland. PA is a medical emergency and a difficult diagnosis to establish. Thus this article reviews the presenting symptoms of PA patients to help clinicians recognize or at least suspect this critical condition early on. PA commonly occurs in the setting of a preexisting adenoma, and several patients are unaware of its existence prior to the onset of apoplexy symptoms, which are mainly of a neurologic, ophthalmologic, and endocrinologic nature. Neurologic symptoms include sudden-onset severe headache and other symptoms of subarachnoid hemorrhage, symptoms from compression of the cavernous sinus contents, nausea/vomiting, impaired consciousness, and symptoms of meningeal irritation. Ophthalmologic symptoms include visual field defects, visual loss, diplopia, and ophthalmoplegia. Endocrinologic disturbances include pituitary adenoma symptoms, cortisol deficiency, panhypopituitarism, diabetes insipidus, and syndrome of inappropriate secretion of antidiuretic hormone. Magnetic resonance imaging is the imaging method of choice to aid the PA diagnosis. Its differential diagnoses include cerebrovascular accidents, infectious diseases, and other causes of endocrinologic imbalance. Transsphenoidal surgery is the treatment of choice, especially if there are associated visual abnormalities and ophthalmoplegia. Clinicians should be aware of the presenting symptoms because early diagnosis may reduce the morbidity and mortality of this neurosurgical emergency.

scholarly journals Multidisciplinary Management of Neuroendocrine Neoplasia: A Real-World Experience from a Referral Center

2019 ◽  
Vol 8 (6) ◽  
pp. 910 ◽  
Author(s):  
Ludovica Magi ◽  
Federica Mazzuca ◽  
Maria Rinzivillo ◽  
Giulia Arrivi ◽  
Emanuela Pilozzi ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Multidisciplinary Approach ◽  
Prospective Observational Study ◽  
Significant Proportion ◽  
Multidisciplinary Management ◽  
Neuroendocrine Neoplasia ◽  
Effective Care ◽  
Data Revision ◽  
Histological Data ◽  
Dedicated Team

Purpose: Multidisciplinary approach is widely advised for an effective care of patients with neuroendocrine neoplasia (NEN). Since data on efficacy of multidisciplinary management of NENs patients in referral centers are scanty, this study aimed at analyzing the modality of presentation and clinical outcome of patients with NENs managed by a dedicated multidisciplinary team. Methods. In this prospective observational study, we included all consecutive new patients visiting the Sant’Andrea Hospital in Rome (ENETS—Center of Excellence) between January 2014 and June 2018. Results. A total of 195 patients were evaluated. The most frequent sites were pancreas (38.5%), small bowel (22%), and lung (9.7%). Median Ki67 was 3%. After the first visit at the center, additional radiological and/or nuclear medicine procedures were requested in 163 patients (83.6%), whereas histological data revision was advised in 84 patients (43.1%) (revision of histological slides: 27.7%, new bioptic sampling: 15.4%). After that, disease imaging staging and grading was modified in 30.7% and 17.9% of patients, respectively. Overall, a change in therapeutic management was proposed in 98 patients (50.3%). Conclusions. Multidisciplinary approach in a dedicated team may lead to change of disease imaging staging and grading in a significant proportion of patients. Enhancing referral routes to dedicated-NEN center should be promoted, since it may improve patients’ clinical outcome.

scholarly journals Postpartum pituitary apoplexy with isolated oculomotor nerve palsy: A rare medical emergency

2015 ◽  
Vol 06 (04) ◽  
pp. 598-600
Author(s):  
Sujeet Raina ◽  
Vaneet Jearth ◽  
Ashish Sharma ◽  
Rajesh Sharma ◽  
Kewal Mistry
Keyword(s):  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Sella Turcica ◽  
Altered Mental Status ◽  
Sudden Onset ◽  
Clinical Syndrome ◽  
Medical Emergency ◽  
Oculomotor Nerve Palsy ◽  
Hormonal Dysfunction ◽  
Third Cranial Nerve Palsy

ABSTRACTPituitary apoplexy is a clinical syndrome characterized by sudden onset headache, visual deficits, ophthalmoplegia, altered mental status, and hormonal dysfunction due to an expanding mass within the sella turcica resulting from hemorrhage or infarction of pituitary gland. We report a case of pituitary apoplexy that developed in postpartum period following postpartum hemorrhage and presented with isolated third cranial nerve palsy.

scholarly journals Acute pituitary apoplexy complicating a pituitary macroadenoma

2010 ◽  
Vol 14 (4) ◽  
pp. 118
Author(s):  
Febin Joseph ◽  
Zarina I Lockhat ◽  
Malan Janse van Rensburg ◽  
Janet Smal ◽  
Tshepo Peter Moja
Keyword(s):  
Pituitary Gland ◽  
Pituitary Apoplexy ◽  
Clinical Syndrome ◽  
Pituitary Macroadenoma ◽  
Altered State ◽  
Visual Defects ◽  
Threatening Condition ◽  
Life Threatening ◽  
Altered State Of Consciousness

Pituitary apoplexy is a rare but potentially life-threatening condition caused by either haemorrhage or infarction of the pituitary gland. In most cases, a pre-existing pituitary macroadenoma is present. Patients present with the clinical syndrome of headache, visual defects or ophthalmoplegia, altered state of consciousness and variable endocrine deficits.

A case of pituitary apoplexy. a acute medical emergency and restitutio ad integrum

2017 ◽  
Author(s):  
Pilar Rodriguez ◽  
Maria Lainez ◽  
Maria Jose Lopez ◽  
Eloisa Roldan ◽  
Isabel Rebollo
Keyword(s):  
Pituitary Apoplexy ◽  
Medical Emergency ◽  
Restitutio Ad Integrum

Multidisciplinary Management of Postoperative Pancreatic Fistula

2021 ◽  
Author(s):  
Alexa Glencer ◽  
Kim Kirkwood ◽  
Adam Schwertner ◽  
Cody Keller ◽  
Mustafa Arain ◽  
...  
Keyword(s):  
Interventional Radiology ◽  
Pancreatic Fistula ◽  
Multidisciplinary Approach ◽  
Postoperative Morbidity ◽  
Postoperative Pancreatic Fistula ◽  
Significant Source ◽  
Successful Outcome ◽  
Multidisciplinary Management ◽  
Economic Strain ◽  
Pancreatic Fistulas

AbstractPostoperative pancreatic fistulas are complex, challenging problems that often take weeks, months, or longer to resolve. Multiple interventions may be required to achieve a successful outcome. As such, resolution typically involves a multidisciplinary approach by a team whose skills include abdominal imaging, specialized surgery, advanced endoscopy, and interventional radiology. Intensive resources and time are often required, which impacts both patients and their caregivers. While treatment(s) continue to improve, a primary goal of research efforts in this area is the prevention of this significant source of postoperative morbidity, mortality, and economic strain.

Multidisciplinary Management of a ‘Double Tooth’

Dental Update ◽  
2021 ◽  
Vol 48 (4) ◽  
pp. 266-270
Author(s):  
Niraj Halai ◽  
Shash Bhakta
Keyword(s):  
Clinical Diagnosis ◽  
Clinical Relevance ◽  
Multidisciplinary Approach ◽  
Case Reports ◽  
Multidisciplinary Management ◽  
Neutral Term

The term double tooth has often replaced the clinical diagnosis of gemination or fusion. If teeth have been extracted or exfoliated, the use of the neutral term ‘double tooth’ avoids the need to arbitrarily decide if it was gemination or fusion in origin. This case reports on a 16-year-old male who presented with an UL2 ‘double tooth’ and his combined restorative, surgical and orthodontic intervention to achieve his ideal result. CPD/Clinical Relevance: A multidisciplinary approach should be adopted when treating patients with a double tooth and an appropriate protocol as cited can be used.

scholarly journals An unrecognized endocrinology emergency masquerading as a hypertensive emergency: A can’t miss diagnosis

2016 ◽  
Vol 4 (1) ◽  
pp. 21
Author(s):  
Yanerys Agosto Vargas ◽  
Sharon Velez Maymi ◽  
Paola Mansilla Letelier ◽  
Luis Raul Hernandez-Vazquez ◽  
Samayra Miranda Rodriguez ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pituitary Adenoma ◽  
Mortality Rate ◽  
Pituitary Gland ◽  
Pituitary Apoplexy ◽  
Systemic Hypertension ◽  
Pituitary Macroadenoma ◽  
Rare Entity ◽  
Factors Associated ◽  
Multiple Risk Factors

Pituitary apoplexy secondary to sellar tumors is a rare entity that carries a high mortality rate. It could be secondary to infarction or hemorrhage of the pituitary gland. The incidence remains unclear, most are reported in men between the ages of 50 to 60. In the majority of times, apoplexy is idiopathic in nature, without a clear discernible cause. However, there are multiple risk factors associated with this entity, such as systemic hypertension, among others. There are few cases of pituitary apoplexy caused by infarction of a pituitary macroadenoma. We present this case of pituitary apoplexy secondary to infarction of a nonfunctional pituitary adenoma in a young woman, with a fortunate resolution.

Sign in / Sign up

Export Citation Format

Share Document