scholarly journals Pituitary apoplexy following endoscopic nasal surgery: A case report

2019 ◽  
Vol 7 ◽  
pp. 2050313X1985586
Author(s):  
Teemu Harju ◽  
Juha Alanko ◽  
Jura Numminen
Keyword(s):  
Pituitary Adenoma ◽  
Pituitary Apoplexy ◽  
Sudden Onset ◽  
Pituitary Macroadenoma ◽  
Nasal Surgery ◽  
Resonance Imaging ◽  
Acute Haemorrhage ◽  
Endoscopic Nasal Surgery ◽  
Precipitating Factor ◽  
Field Defects

Pituitary apoplexy develops as a consequence of acute haemorrhage and/or infarction in a pre-existing pituitary adenoma. Typical symptoms include sudden onset headache, visual acuity/field defects, and ocular palsies. We report a male patient with a known pituitary macroadenoma who underwent a right-sided endoscopic nasal surgery. Preoperatively, thickening of sphenoid mucosa was seen in computed tomography and magnetic resonance imaging. The patient developed pituitary apoplexy postoperatively. The presented report indicates that in patients with a pituitary adenoma, nasal surgery – like any other kind of surgery – is a possible precipitating factor for pituitary apoplexy. Isolated thickening of sphenoid mucosa is associated with pituitary apoplexy. It may also precede an apoplectic event.

scholarly journals Pituitary apoplexy causing acute ischemic stroke: Which treatment should be given priority

2020 ◽  
Vol 11 ◽  
pp. 113 ◽  
Author(s):  
Jae-Min Ahn ◽  
Hyuk-Jin Oh ◽  
Jae-Sang Oh ◽  
Seok-Mann Yoon
Keyword(s):  
Pituitary Adenoma ◽  
Cerebral Ischemia ◽  
Pituitary Apoplexy ◽  
Rare Complication ◽  
Sudden Onset ◽  
Pituitary Macroadenoma ◽  
Conventional Angiography ◽  
Pituitary Dysfunction ◽  
Acute Cerebral Ischemia

Background: Pituitary apoplexy is syndrome of sudden onset of headache, visual loss, pituitary dysfunction, and altered consciousness. Pituitary apoplexy followed by acute cerebral ischemia is extremely rare. Here, we introduced the case of successful surgical resection of pituitary adenoma which induced acute cerebral ischemia. Case Description: A 78-year-old man with a known pituitary macroadenoma presented with decreased consciousness and left hemiparesis. Magnetic resonance image (MRI) and computed tomography (CT) showed large pituitary macroadenoma with hemorrhage and diffusion-perfusion mismatch of right internal carotid artery (ICA) territory. Conventional angiography was done and severe stenosis of bilateral ICA and prominent flow delay of left ICA were noted at paraclinoid segment. Microscopic tumor mass removal with transsphenoidal approach was performed. Final pathological diagnosis was pituitary adenoma with apoplexy. Immediately after surgery, his symptoms were disappeared. Follow-up image studies revealed much improved perfusion in right ICA territory and patency of bilateral ICAs. Conclusion: Direct compression of ICA is rare complication of pituitary apoplexy, which caused cerebral ischemia. Conventional angiography should be necessary for accurate diagnosis and prompt surgical decompression should be the treatment of choice.

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 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.

scholarly journals Metastasis of a Dorsal Melanoma to a Pituitary Adenoma Mimicking Pituitary Apoplexy

2017 ◽  
Vol 36 (04) ◽  
pp. 238-242
Author(s):  
Rui Ramos ◽  
Maria Machado ◽  
Cristiano Antunes ◽  
Vera Fernandes ◽  
Olinda Marques ◽  
...  
Keyword(s):  
Differential Diagnosis ◽  
Pituitary Adenoma ◽  
Adjuvant Radiotherapy ◽  
Transsphenoidal Surgery ◽  
Pituitary Apoplexy ◽  
Clinical Presentation ◽  
Pituitary Macroadenoma ◽  
Histology Result ◽  
History Of ◽  
Transcranial Approach

AbstractMetastases to pituitary adenomas are very rare. From the 20 cases found in the literature, none originated from a cutaneous melanoma. We present the case of a 67-year-old man with a history of transcranial approach to treat a pituitary macroadenoma followed by adjuvant radiotherapy. Fifteen years later, he presented a dorsal nodular melanoma, and three years after that, he developed symptoms of pituitary apoplexy. He was submitted to transsphenoidal surgery, and the histology result revealed metastasis of the melanoma into a pituitary adenoma.The similarity in the clinical presentation of the two entities—pituitary apoplexy and metastasis of the melanoma into a pituitary adenoma—and the rarity of this type of metastization alert to challenges in the differential diagnosis that may confound the neurosurgeon's decision.

scholarly journals Successful Pregnancy in a Female with a Large Prolactinoma after Pituitary Tumor Apoplexy

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Butheinah A. Al-Sharafi ◽  
Omar H. Nassar
Keyword(s):  
Magnetic Resonance Imaging ◽  
Pituitary Adenoma ◽  
Magnetic Resonance ◽  
Pituitary Apoplexy ◽  
Rare Condition ◽  
Empty Sella ◽  
Resonance Imaging ◽  
Successful Pregnancy ◽  
Empty Sella Syndrome ◽  
History Of

Pituitary apoplexy is a rare condition which may cause death of the patient in severe cases and many times leads to hypopituitarism. We report a case of apoplexy in a large prolactinoma resulting in empty sella syndrome followed by a successful pregnancy. Our patient is a 32-year-old female with a history of a macroprolactinoma for approximately 17 years who presented to our hospital with a history of severe headache, decreased level of consciousness, fever, nausea, vomiting, and diplopia of 12 hours duration. Magnetic resonance imaging done on admission showed an increase in the size of the pituitary adenoma with a subtle hemorrhage. The patient was admitted to the intensive care unit and treated conservatively. The condition of the patient improved within a few days. A few months later, she started having regular menstrual periods. A magnetic resonance imaging of the pituitary 1.5 years later was reported as empty sella syndrome, and approximately one year later she became pregnant. With the pituitary adenoma being resolved after developing pituitary apoplexy and continuing on cabergoline, the patient had a successful pregnancy with no recurrence of the adenoma after delivery and breastfeeding.

Chiasmal Syndromes

2019 ◽  
pp. 61-66
Author(s):  
Matthew J. Thurtell ◽  
Robert L. Tomsak
Keyword(s):  
Visual Field ◽  
Clinical Features ◽  
Pituitary Apoplexy ◽  
Optic Chiasm ◽  
Surgical Decompression ◽  
Visual Field Defects ◽  
Pituitary Macroadenoma ◽  
Visual Recovery ◽  
Field Defects ◽  
Pituitary Macroadenomas

Dysfunction of the optic chiasm typically produces bitemporal hemianopic visual field defects. Optic chiasmal dysfunction most often results from compression by extrinsic lesions, such as pituitary macroadenomas and meningiomas. In this chapter, we begin by describing the various bitemporal hemianopic visual field defects that can occur with optic chiasmal dysfunction. We next list potential causes of optic chiasmal dysfunction. We then review the clinical features and evaluation of pituitary apoplexy, which results from infarction of (or hemorrhage into) a pituitary macroadenoma. Lastly, we discuss the management of pituitary apoplexy, including the indications for and timing of surgical decompression, and review factors that affect the prognosis for visual recovery.

scholarly journals Pituitary Adenoma with Apoplexy with Arteriovenous Malformation

2017 ◽  
Vol 06 (01) ◽  
pp. 059-061
Author(s):  
Rajeev Bansal ◽  
Jitendra Shekhawat ◽  
Devendra Purohit
Keyword(s):  
Pituitary Adenoma ◽  
Arteriovenous Malformation ◽  
Pituitary Apoplexy ◽  
Single Case ◽  
Mass Effect ◽  
Sudden Onset ◽  
Sudden Loss ◽  
Rare Association ◽  
Chief Complaints

Background This is a rare association of pituitary adenoma with apoplexy with arteriovenous malformation as only single case was reported prior to this case as per our knowledge. Case Description A 25-year-old man presented with chief complaints of headache of sudden onset, severe in intensity with sudden loss of vision. Imaging shows pituitary adenoma with apoplexy with right parietal arteriovenous malformation. The patient was managed with embolization for parietal arteriovenous malformation and medically for pituitary adenoma with apoplexy. Conclusion Pituitary apoplexy can be treated conservatively if no features of mass effect present. Follow-up of the patient must be done regularly to look for the size of pituitary adenoma and recurrence of arteriovenous malformation.

Clinical versus Subclinical Pituitary Apoplexy: Presentation, Surgical Management, and Outcome in 21 Patients

Neurosurgery ◽  
1990 ◽  
Vol 26 (6) ◽  
pp. 980-986 ◽  
Author(s):  
Stephen T. Onesti ◽  
Thomas Wisniewski ◽  
Kalmon D. Post
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Pituitary Apoplexy ◽  
Clinical Signs ◽  
Sudden Onset ◽  
Resonance Imaging ◽  
Duration Of Symptoms ◽  
Computed Tomographic ◽  
Sellar Tumor

Abstract A retrospective review of 16 consecutive patients with pituitary apoplexy treated over a 10-year period is reported. Eight men and 8 women (mean age, 48 years) underwent transsphenoidal decompression after an average duration of symptoms of 19 days. The diagnosis of pituitary apoplexy was made by the sudden onset of headache (88%), nausea (56%), or meningismus (13%), with or without visual disturbances (75%), in the setting of a sellar tumor on computed tomographic or magnetic resonance imaging scans. Thirteen of 16 patients showed significant improvement of symptoms after surgery (average follow-up, 2.5 years). In addition, 5 patients with clinically silent yet extensive pituitary hemorrhage were treated. Although extensive pituitary hemorrhage often produced fulminant apoplexy, it also presented insidiously over many days with few, if any, clinical signs. Rapid diagnosis, endocrine replacement, and transsphenoidal decompression constituted effective therapy. Magnetic resonance imaging (after at least 12 hours of symptoms) was superior to computed tomography in detecting hemorrhage.

scholarly journals Postoperative Urinary Retention Following General Anesthesia for Endoscopic Nasal Surgery in Men Aged Older Than 60 Years: A Retrospective Study

2021 ◽  
pp. 014556132110331
Author(s):  
Yong Won Lee ◽  
Bum Sik Kim ◽  
Jihyun Chung
Keyword(s):  
General Anesthesia ◽  
Incidence Rate ◽  
Urinary Retention ◽  
Nasal Surgery ◽  
Prostate Hyperplasia ◽  
Postoperative Urinary Retention ◽  
Asa Classification ◽  
History Of ◽  
Male Patients ◽  
Endoscopic Nasal Surgery

Objectives: Postoperative urinary retention (POUR) is influenced by many factors, and its reported incidence rate varies widely. This study aimed to investigate the occurrence and risk factors for urinary retention following general anesthesia for endoscopic nasal surgery in male patients aged >60 years. Methods: A retrospective review of medical records between January 2015 and December 2019 identified 253 patients for inclusion in our study. Age, body mass index (BMI), a history of diabetes/hypertension, American Society of Anesthesiologists (ASA) classification, and urologic history were included as patient-related factors. Urologic history was subdivided into 3 groups according to history of benign prostate hyperplasia (BPH)/lower urinary tract symptoms (LUTS) and current medication. The following was analyzed as perioperative variables for POUR development: duration of anesthesia and surgery; amount of fluid administered; rate of fluid administration; intraoperative requirement for fentanyl, ephedrine, and dexamethasone; postoperative pain; and analgesic use. Preoperatively measured prostate size and uroflowmetry parameters of patients on medication for symptoms were compared according to the incidence of urinary retention. Results: Thirty-seven (15.7%) patients developed POUR. Age (71.4 vs 69.6 years), BMI (23.9 vs 24.9 kg/m2), a history of diabetes/hypertension, ASA classification, and perioperative variables were not significantly different between patients with and without POUR. Only urologic history was identified as a factor affecting the occurrence of POUR ( P = .03). The incidence rate among patients without urologic issues was 5.9%, whereas that among patients with BPH/LUTS history was 19.8%. Among patients taking medication for symptoms, the maximal and average velocity of urine flow were significantly lower in patients with POUR. Conclusions: General anesthesia for endoscopic nasal surgery may be a potent trigger for urinary retention in male patients aged >60 years. The patient’s urological history and urinary conditions appear to affect the occurrence of POUR.

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