Ophthalmologic Aspects of Pituitary Apoplexy

1996 ◽  
Vol 6 (1) ◽  
pp. 69-73 ◽  
Author(s):  
S. Milazzo ◽  
P. Toussaint ◽  
F. Proust ◽  
G. Touzet ◽  
D. Malthieu
Keyword(s):  
Retrospective Study ◽  
Pituitary Adenoma ◽  
Medical Treatment ◽  
Ct Scan ◽  
Pituitary Adenomas ◽  
Emergency Treatment ◽  
Pituitary Apoplexy ◽  
Surgical Removal ◽  
Visual Abnormalities ◽  
Visual Disturbances

Pituitary apoplexy is an acute hemorragic or ischemic infarction in pituitary adenomas. The incidence in our series was 6.5%. Clinical diagnosis can often be difficult as the patient is frequently unaware of an existing adenoma (seven out of 11 patients). Therefore, the classic features of the syndrome must be known. They include sudden headaches, impairment of consciousness, endocrinological disturbances and sudden visual deterioration or oculomotor palsies. In this retrospective study from 1987 to 1994 of 14 patients presenting pituitary apoplexy there were 11 cases with visual abnormalities. Oculomotor palsies were more common (82%) than chiasmatic impairment (54.5%) and often revealed pituitary adenoma. CT-Scan and MRI examinations led to diagnosis, and emergency treatment (surgical removal by rhinoseptal approach or less often medical treatment) generally led to a regression of visual disturbances.

scholarly journals Thyrotropin-Secreting Pituitary Adenoma Successfully Treated With Cabergoline

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A967-A968
Author(s):  
Aisha R Saand ◽  
Monica Flores ◽  
Sura Alqaisi ◽  
Ossama Lashin
Keyword(s):  
Pituitary Adenoma ◽  
Medical Treatment ◽  
Pituitary Adenomas ◽  
Reference Range ◽  
Clinical Manifestations ◽  
Alternative Form ◽  
Thyroid Function Tests ◽  
Invasive Treatment ◽  
Α Subunit

Abstract Background: Thyrotropin secreting pituitary adenomas (TSH-oma) account for less than 1% of pituitary adenomas and are a rare cause of hyperthyroidism. In this case, we describe the safe use of cabergoline with the subsequent achievement of euthyroid levels and the resolution of symptoms. Clinical Case: A 67-year-old female with a presumed history of hypothyroidism for the last 3 years managed with Armour thyroid was referred for fatigue associated with palpitations, intermittent diarrhea, insomnia, and anxiety. Her TSH was noted to be suppressed at that time, and her Amour thyroid was changed to Levothyroxine 25 mcg daily, which was eventually stopped as her symptoms persisted. Follow-up thyroid function tests (TFTs) showed elevated TSH (8.60 µU/mL, reference range 0.340 - 5.600 µU/mL), and elevated free T3 (10.8 pg/mL, reference range 2.7-4.7 pg/mL) and free T4 (2.0 ng/dL, reference range 0.8-1.5 ng/dL) levels. Further laboratory workup including basal prolactin, LH, FSH, hCG α-subunit, IGF-1, and ACTH levels were within the normal range. Physical examination showed diffuse thyroid enlargement. An I-123 thyroid uptake and scan showed uniform uptake throughout the gland with no focal hyperintense areas. A dedicated pituitary MRI was performed and revealed an 8 mm microadenoma in the posterior left adenohypophysis. The patient wanted to avoid any invasive treatment and refused trans-sphenoidal surgery and medical therapy was chosen. Unfortunately, using a somatostatin analog as part of the standard medical treatment was not an option due to the high cost and lack of insurance coverage. For these reasons, a trial of cabergoline was started to suppress TSH secretion. Atenolol 25 mg daily was added temporarily for the management of her sympathetic symptoms. On periodic follow-up, her symptoms gradually subsided, and TFTs remained within normal limits. Treatment was continued for one year. Conclusion: Clinical manifestations of hyperthyroidism with biochemical evidence of elevated thyroid hormone levels and TSH levels should raise a strong suspicion for central or secondary hyperthyroidism due to TSH secreting pituitary adenoma. Cabergoline might represent an effective alternative form of medical treatment for TSH-oma in certain situations where the first line therapeutic options are refractory, contraindicated, or declined.

Acute stroke in pituitary adenomas complicated by pituitary apoplexy

2016 ◽  
Vol 21 (3) ◽  
pp. 136-139
Author(s):  
Miralim M. Azizov
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Apoplexy ◽  
Clinical Signs ◽  
Pituitary Tumors ◽  
Clinical Syndrome ◽  
Left Internal Carotid Artery ◽  
Left Middle Cerebral Artery ◽  
Ischemic Brain ◽  
Left Middle ◽  
Visual Disturbances

Pituitary apoplexy is a clinical syndrome that is manifested by headache, visual disturbances, ophthalmoplegia or impaired consciousness. It can develop as a result of necrosis or hemorrhage in the pituitary gland or in cases of pituitary tumors. A favorable prognosis is possible if early diagnosis and timely surgical treatment. Pituitary apoplexy complicated by the disorder of the cerebral circulation occurs relatively rare. We observed the female patient aged of 51 year with pituitary adenoma, clinical signs of which were sudden depression of consciousness, right hemiparesis and left-sided ptosis. Signs of pituitary apoplexy were revealed after performed examinations. The sharp increase in the size of the tumor resulted in a compression of supraclinoid portion of the left internal carotid artery, which was the cause of ischemic brain damage in the pool left middle cerebral artery. After 2 weeks of conservative treatment, the patient was undergone to the surgery via transsphenoidal access. Histological examination confirmed the hemorrhage and necrosis of the pituitary adenoma. Complication developed 3 months after surgery partially regressed. Taking into account the relatively rare occurrence of pituitary apoplexy complicated with cerebrovascular ischemic type, clinicians should be alert to this complication. The method of choice is transsphenoidal delayed adenomectomy with conservative therapy.

scholarly journals SURG-08. SURGICAL OUTCOMES OF PITUITARY ADENOMAS TREATED WITH TRANSSPHENOIDAL SURGERY: A SINGLE INSTITUTION’S EXPERIENCE

2019 ◽  
Vol 21 (Supplement_6) ◽  
pp. vi241-vi241
Author(s):  
Young Beom Seo ◽  
Oh-Lyong Kim
Keyword(s):  
Growth Hormone ◽  
Pituitary Adenoma ◽  
Surgical Outcomes ◽  
Pituitary Adenomas ◽  
Transsphenoidal Surgery ◽  
Cerebrospinal Fluid Leakage ◽  
Time Interval ◽  
Tumor Type ◽  
Visual Disturbances

Abstract We retrospectively analyzed surgical outcomes of transsphenoidal surgery for pituitary adenomas. A total of 366 consecutive patients undergoing transsphenoidal surgery for a pituitary adenoma from December 1990 through May 2017 were included in this study. The most common tumor type was nonfunctioning pituitary adenoma (NFPA) (63.7%), followed by prolactin-secreting adenoma (20.5%), growth hormone-secreting adenoma (13.4%), adrenocorticotropin-secreting adenoma (2.2%), and thyrotropin-secreting adenoma (0.2%). This cohort study consisted of 164 male and 202 female patients. The median patients age was 48 years. The median follow-up duration was 63 months. Gross-total resection (GTR) was achieved in 83.7% of patients with a NFPA, 76% of prolactin-secreting adenomas, 71.4% of growth hormone-secreting adenomas, 75% of adrenocorticotropin-secreting adenomas, 100% of thyrotropin-secreting adenomas. There were 326 macroadenomas (69.1%). Surgical outcome was better in patients with microadenomas than in patients with macroadenomas (100% and 77.9%, respectively). Improvement of visual disturbances occurred in 148 (93.7%) of the 158 cases. Hormonal impairment by pituitary adenoma was improved in 105 (87.5%) of the 120 cases. There were 24 (8.2%) cases of recurrence after GTR; 17 patients underwent second surgery, 5 patients received radiotherapy, and the others continued conservative treatment. The median time interval between TSA and recurrence was 56 months. Postoperative cerebrospinal fluid leakage occurred in seven (1.9%) of 366 patients. Transsphenoidal surgery is an effective and safe treatment modality for most patients with pituitary adenoma.

Changes in clinicopathological profile post Trans-sphenoidal surgery in patients with Pituitary Adenomas: An Institute based study from North East India

2020 ◽  
Vol 17 (1) ◽  
pp. 36-40
Author(s):  
Hirak Mookherjee ◽  
Vijay Kumar Gupta ◽  
Sanjeev Attry
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Clinical Symptoms ◽  
Common Symptom ◽  
North East India ◽  
North East ◽  
Clinicopathological Profile ◽  
Male Patients ◽  
Study Participants ◽  
Visual Disturbances

Introduction: Pituitary adenomas are common intracranial neoplasms. In this study, we report the changes in clinical features and hormone profile in patients of pituitary adenoma following transsphenoidal surgery. Patients and methods: Thirty consecutive cases of pituitary adenoma diagnosed and operated at Bangur Institute of Neurosciences, West Bengal, India were followed up for clinical and hormonal profile resolution following trans-sphenoidal surgery between December 2010 and November 2012. The patient group included 14 female and 16 male patients and the mean age of patients was 35.86 years (range: 14–58 years). Results: Fifteen (50%) cases were non-functioning adenomas. Among the hormonally active pituitary adenoma, prolactin-producing adenomas were most common (66.67%), followed by growth hormone-producing adenomas (20%) and adrenocorticotrophic hormone-producing adenomas (13.33%). The most common symptom was headache and visual disturbances. Menstrual disturbances and galactorrhea were observed in six and two females respectively out of the 14 females in the study participants. Resolution of symptoms was reported by majority of our patients and hormonal derangement was corrected in 30% of our study subjects. Conclusion: We report 30 patients with pituitary adenoma who underwent surgery. Resolution of clinical symptoms and endocrine functions was observed in the majority of our patients.  

Pituitary apoplexy: its incidence and clinical significance

1981 ◽  
Vol 55 (2) ◽  
pp. 187-193 ◽  
Author(s):  
Susumu Wakai ◽  
Takanori Fukushima ◽  
Akira Teramoto ◽  
Keiji Sano
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Adenomas ◽  
Pituitary Apoplexy ◽  
Clinical Symptoms ◽  
Consecutive Series ◽  
Content Type ◽  
Histological Types ◽  
Hormonal Function ◽  
A Minor ◽  
Fine Print

✓ The occurrence of hemorrhage from pituitary adenoma (so-called “pituitary apoplexy”) was investigated in a consecutive series of 560 cases operated on during the past 30 years. There were 93 cases (16.6%) in which hemorrhage from pituitary adenomas was confirmed either clinically or surgically. These patients were analyzed in terms of age, sex, symptoms and signs, size of tumor, hormonal function, and histological types of adenomas, and computerized tomography findings. In 90 cases (16.1%), hematoma or old bloody fluid was verified within the tumor tissue at surgery. Three other patients presented with subarachnoid hemorrhage, but there was no detectable intratumor hematoma in any of them. Among these 93 patients, 42 (7.5%) showed no evidence of clinical symptoms related to hemorrhage (asymptomatic hemorrhage). Fifty-one patients (9.1%) had definite histories of an acute episode that suggested sudden bleeding (symptomatic hemorrhage: pituitary apoplexy). Thirty-eight patients (6.8%) had a major attack manifested by disturbances of consciousness, hemiparesis, loss of vision, or ocular palsy. In two acromegalic patients, pituitary apoplexy developed during bromocriptine treatment. There was one case of sudden death due to massive hemorrhage from the tumor 14 months after the completion of postoperative radiation therapy. The other 13 symptomatic patients (2.3%) developed a minor attack which included headache, nausea, vomiting, and vertigo. Bleeding from pituitary adenomas was not statistically correlated with any of the following factors: sex, hormonal function of adenomas, and histological types, but it was correlated with age. The number of asymptomatic cases in the third decade was significantly greater than that of the whole group of pituitary adenoma patients in the same decade. The present investigation revealed that the incidence of pituitary apoplexy was unexpectedly high: a major attack in 6.8% of pituitary adenoma patients, a minor attack in 2.3%, and asymptomatic hemorrhage in 7.5% of the cases. This risk of pituitary apoplexy should be kept in mind in treating pituitary adenomas.

scholarly journals A Rare Case of Thyrotropin Secreting Pituitary Macroadenoma Primarily Treated With Somatostatin Analogue

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A568-A568
Author(s):  
Arwa Mahmoud Elsheikh ◽  
G Edward Vates ◽  
Ismat Shafiq
Keyword(s):  
Pituitary Adenoma ◽  
Medical Treatment ◽  
Thyroid Function ◽  
Pituitary Adenomas ◽  
Rare Case ◽  
Somatostatin Analogues ◽  
Primary Treatment ◽  
Alpha Subunit ◽  
Somatostatin Analogue ◽  
Pituitary Macroadenoma

Abstract Introduction/Background: Thyrotropin secreting pituitary adenomas (TSH-oma) are a rare cause of hyperthyroidism. They account for <1% of the cases of hyperthyroidism with a reported incidence of 2.8 per 1 million in Sweden. Diagnosis is suspected by the presence of elevated T4 and T3 in the setting of an unsuppressed TSH level. The presence of large pituitary adenoma is highly suggestive of the diagnosis and can be differentiated from thyroid hormone resistance by elevated alpha subunit and SHBG levels. Trans-sphenoidal surgery is the definitive treatment. Peri-operative medical treatment with somatostatin analogues is indicated to achieve euthyroidism and prevent surgical risks and thyroid storm. The use of somatostatin analogues as a primary treatment for TSH-oma is still under investigation. We hereby report a rare case of TSH-oma where somatostatin analogues successfully resulted in normalization of thyroid function and tumor size reduction. Clinical Case: A 61 years old gentleman with a history of hypothyroidism diagnosed three years before presentation to the Pituitary clinic. He was treated with Levothyroxine. On clinical examination, he had mild tremor and warm sweaty palms with no stigmata of Grave’s disease. The thyroid function test showed elevated free T4 of 3.6 ng/dl (0.9-1.7), elevated free T3 of 8.6 pg/ml (2.0-4.4), and a high TSH level of 9.10 μIU/ml (0.27-4.20). His prolactin level was mildly elevated at 24.8 ng/ml(4.0-15.2). Testosterone, IGF-1, and cortisol levels were normal. An MRI of his pituitary gland showed large pituitary macroadenoma with supra-sellar extension and mild compression of the optic nerve. He had an elevated alpha subunit of 5.6 ng/ml (<1.37) and a high SHBG level of 198 nmol/l(10-80). TSH adenoma was diagnosed and he was planned for trans-sphenoidal surgery. Pre-operative treatment with somatostatin analogue Lanerotide 90 mg monthly injection was initiated. Interestingly normal thyroid function was observed approximately 1 month after his first injection. Repeat MRI showed a considerable decrease in the size of the pituitary macroadenoma. The patient opted to hold on to surgery and to continue on medical treatment. His thyroid function remains normal 15 months after initiation of treatment and his MRI continues to show stable pituitary adenoma. Conclusion: Somatostatin analogues can be used as a primary treatment for thyrotropin secreting pituitary adenomas when the patient is unable or unwilling to undergo surgery. It is use is associated with normalization of thyroid function and in some cases with a reduction in the adenoma size.

scholarly journals Agyalapimirigy-apoplexia.

2021 ◽  
Vol 162 (38) ◽  
pp. 1520-1525
Author(s):  
László Sipos ◽  
Nikolette Szücs ◽  
Péter Várallyay
Keyword(s):  
Pituitary Adenoma ◽  
Retrospective Studies ◽  
Pituitary Apoplexy ◽  
Sudden Onset ◽  
Clinical Syndrome ◽  
Resonance Imaging ◽  
Altered Consciousness ◽  
Wait And See ◽  
Neurosurgical Intervention ◽  
Visual Disturbances

Összefoglaló. Az agyalapimirigy-apoplexia ritka klinikai kórkép, mely hirtelen kialakult bevérzés vagy infarktus következményeként jelenik meg. A hypophysisadenomás betegek 2–12%-ában fordul elő, a leggyakrabban funkcionálisan inaktív daganatokban, de jelentkezhet gyógyszeresen kezelt adenomákban is. Klinikai képe hirtelen kialakuló heves fejfájás, mely látászavarral vagy kettős látással társulhat, de meningealis izgalmi jel, a tudati szint romlása is előfordulhat. A bevérzés miatt kialakult kortikotropinhiány kezelés nélkül mellékvese-elégtelenséghez vezet. A mágneses rezonancia a komputertomográfhoz képest jobban kimutatja az adenoma bevérzését vagy akár infarktusát. Retrospektív tanulmányok a korábbi, azonnali idegsebészeti beavatkozás helyett a konzervatív kezelés létjogosultságát emelik ki. Orv Hetil. 2021; 162(38): 1520–1525. Summary. Pituitary apoplexy is a rare clinical syndrome secondary to haemorrhage or infarction of pituitary adenoma. The prevalence is 2–12% of pituitary adenoma patients especially in nonfunctioning tumours but may be found in medically treated adenomas as well. Its clinical picture is sudden onset of headache with visual disturbances and/or ocular palsy. Meningeal signs and altered consciousness can occur. Corticotropin deficiency if untreated can lead to adrenal insufficiency. Compared to computed tomography, magnetic resonance imaging better demonstrates the haemorrhage or even infarction of pituitary adenoma. Retrospective studies emphasize the wait-and-see management instead of the formerly considered urgent neurosurgical intervention. Orv Hetil. 2021; 162(38): 1520–1525.

scholarly journals A rare case of SARS-CoV-2 infection associated with pituitary apoplexy without comorbidities

2021 ◽  
Author(s):  
Ritwik Ghosh ◽  
Dipayan Roy ◽  
Devlina Roy ◽  
Arpan Mandal ◽  
Aloke Dutta ◽  
...  
Keyword(s):  
Infectious Disease ◽  
Pituitary Adenoma ◽  
Cranial Nerve ◽  
Rare Case ◽  
Pituitary Apoplexy ◽  
Healthy Woman ◽  
Thunderclap Headache ◽  
Pathophysiological Mechanisms ◽  
Surgical Emergency ◽  
Visual Disturbances

Abstract Pituitary apoplexy is a medical and surgical emergency caused by hemorrhage or infarction of the hypophysis, which typically occurs within a pituitary adenoma. It is usually characterized by severe (often thunderclap) headache, visual disturbances, cranial nerve impairments and hormonal deficiencies. We herein report a case of a previously healthy woman with SARS-CoV-2 infection associated with pituitary apoplexy. The plausible pathophysiological mechanisms of pituitary apoplexy in 2019 coronavirus infectious disease (COVID-19) are discussed.

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