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

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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Masked Pituitary Macroadenoma Presenting as Pituitary Apoplexy Triggered by Sepsis in Postpartum Period-A Rare Case Report

Journal of Pharmaceutical Research International ◽

10.9734/jpri/2021/v33i37a31973 ◽

2021 ◽

pp. 12-16

Author(s):

Nicole Dound ◽

Sandhya Pajai ◽

Neema Acharya ◽

Sourya Acharya ◽

Chitra Dound

Keyword(s):

Rare Case ◽

Pituitary Apoplexy ◽

Altered Mental Status ◽

Postpartum Woman ◽

Pituitary Macroadenoma ◽

Rare Occurrence ◽

Common Cause ◽

Rare Case Report ◽

Visual Disturbances

Apoplexy of the Pituitary gland is rarely seen critical disorder marked by acute throbbing of head / altered mental status / visual disturbances /decreased consciousness, due to sudden haemorrhagic changes of the pituitary or infarction of the same. There are numerous factors which precipitate apoplexy of the pituitary, sepsis being one of the least common cause, as is elaborated in this case study. Inspite of having a distinctive presentation, pituitary apoplexy eludes diagnosis and proper management as it is complicated by related co-morbidities. Its occurrence in a postpartum lady is an even rarer incident. This article shows a rare occurrence of apoplexy of macroadenoma in a postpartum woman which was managed conservatively.

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Acute stroke in pituitary adenomas complicated by pituitary apoplexy

Russian Journal of Oncology ◽

10.18821/1028-9984-2016-21-3-136-139 ◽

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.

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RECURRENT PITUITARY APOPLEXY IN AN ADENOMA WITH SWITCHING PHENOTYPES

AACE Clinical Case Reports ◽

10.4158/accr-2019-0273 ◽

2020 ◽

Vol 6 (5) ◽

pp. e221-e224

Author(s):

Teresa V. Brown ◽

Khadeen C. Cheesman ◽

Kalmon D. Post

Keyword(s):

Pituitary Adenoma ◽

Luteinizing Hormone ◽

Cranial Nerve ◽

Adrenocorticotropic Hormone ◽

Pituitary Apoplexy ◽

Follicle Stimulating Hormone ◽

Pituitary Tumors ◽

Acute Onset ◽

Cranial Nerve Palsies ◽

Stimulating Hormone

Objective: To describe an unusual presentation of a patient with recurrent pituitary apoplexy of an adenoma that switched phenotypes from a nonfunctioning, or silent gonadotroph adenoma (SGA), to a silent corticotroph adenoma (SCA). We discuss the potential etiologies of both recurrent pituitary apoplexy and phenotype switching of pituitary tumors. Methods: The presented case includes clinical and biochemical findings, surgical outcomes, and pathologic reports related to the treatment of our patient who presented with recurrent pituitary apoplexy. Results: A 56-year-old man presented for evaluation of decreased libido and was found to have a low testosterone level. A pituitary magnetic resonance image demonstrated an 8-mm pituitary adenoma. He underwent transsphenoidal surgery (TSS) to remove the tumor and pathology demonstrated an SGA immunopositive for luteinizing hormone and follicle-stimulating hormone with evidence of apoplexy. Eight years later, the patient underwent another TSS after developing acute-onset headache, vomiting, and a cranial nerve palsy. Pathology at this time showed a necrotic tumor consistent with apoplexy with negative immunostains for all pituitary tumors. Three years after this, the tumor recurred and after another TSS the tumor stained positive for adrenocorticotropic hormone but was negative for luteinizing hormone and follicle-stimulating hormone with hemorrhage consistent with apoplexy. A few years afterward, he again developed acute-onset headache and cranial nerve palsies and had another TSS. On pathology, the tumor demonstrated extensive necrosis consistent with apoplexy and again stained positive for adrenocorticotropic hormone. The patient was then referred for radiation therapy and was subsequently lost to follow up. Conclusion: Recurrent pituitary apoplexy in the same patient has only been described 3 times in the literature. There have been no case reports of a pituitary adenoma that switched phenotypes from an SGA to SCA. We suggest that pituitary apoplexy may recur multiple times due to a tumor with particularly fragile vessel walls and increased vascularization. We review the literature that suggests clinical and molecular similarities between SGAs and SCAs. Further studies are needed to determine the etiologies of recurrent apoplexy and pituitary adenomas with switching phenotypes.

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Agyalapimirigy-apoplexia.

Orvosi Hetilap ◽

10.1556/650.2021.32209 ◽

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.

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Ophthalmologic Aspects of Pituitary Apoplexy

European Journal of Ophthalmology ◽

10.1177/112067219600600114 ◽

1996 ◽

Vol 6 (1) ◽

pp. 69-73 ◽

Cited By ~ 22

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.

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Endoscopic Endonasal Transtuberculum Transplanum Approach for Resection of Giant Pituitary Adenoma: The Second Floor Strategy to Avoid Postoperative Pituitary Apoplexy

10.1055/s-0040-1702625 ◽

2020 ◽

Author(s):

Dante L. Pezzutti ◽

Daniel M. Prevedello

Keyword(s):

Pituitary Adenoma ◽

Pituitary Apoplexy ◽

Endoscopic Endonasal ◽

Giant Pituitary Adenoma

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A rare case of spontaneously cured acromegaly by the apoplexy of the pituitary adenoma

Endocrine Abstracts ◽

10.1530/endoabs.67.gp30 ◽

2019 ◽

Author(s):

Carla L Scanteie ◽

Silviu Crainic ◽

Cristina Ghervan

Keyword(s):

Pituitary Adenoma ◽

Rare Case

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Pituitary apoplexy induced by gonadotropin-releasing hormone (GnRH) agonist administration for treatment of prostate cancer: a systematic review

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s00432-021-03697-1 ◽

2021 ◽

Author(s):

Rishi Raj ◽

Ghada Elshimy ◽

Aasems Jacob ◽

P. V. Akhila Arya ◽

Dileep C. Unnikrishnan ◽

...

Keyword(s):

Prostate Cancer ◽

Systematic Review ◽

Pituitary Adenoma ◽

Gnrh Agonist ◽

Tumor Size ◽

Pituitary Apoplexy ◽

Clinical Presentation ◽

Pituitary Surgery ◽

Laboratory Evaluation ◽

The Mean

Abstract Objective We aimed to review of literature on the clinical presentation, management and outcomes of pituitary apoplexy following gonadotrophic release hormone (GnRH) agonist administration for the treatment of prostate cancer. Methods We used PRISMA guidelines for our systematic review and included all English language original articles on pituitary apoplexy following GnRH agonist administration among prostate cancer patients from Jan 1, 1995 to Dec 31, 2020. Data on patient demographics, prostate cancer type, Gleason score at diagnosis, history of pituitary adenoma, clinical presentation, GnRH agonist, interval to pituitary apoplexy, laboratory evaluation at admission, radiologic findings, treatment of pituitary apoplexy, time to surgery if performed, pathology findings, and clinical/hormonal outcomes were collected and analyzed. Results Twenty-one patients with pituitary apoplexy met our inclusion criteria. The mean age of patients was 70 (60–83) years. Leuprolide was the most common used GnRH agonist, used in 61.9% of patients. Median duration to symptom onset was 5 h (few minutes to 6 months). Headache was reported by all patients followed by ophthalmoplegia (85.7%) and nausea/vomiting (71.4%). Three patients had blindness at presentation. Only 8 cases reported complete anterior pituitary hormone evaluation on presentation and the most common endocrine abnormality was FSH elevation. Tumor size was described only in 15 cases and the mean tumor size was 26.26 mm (18–48 mm). Suprasellar extension was the most common imaging finding seen in 7 patients. 71.4% of patients underwent pituitary surgery, while 23.8% were managed conservatively. Interval between symptoms onset to pituitary surgery was 7 days (1–90 days). Gonadotroph adenoma was most common histopathologic finding. Clinical resolution was comparable, while endocrine outcomes were variable among patients with conservative vs surgical management. Conclusion Although the use of GnRH agonists is relatively safe, it can rarely lead to pituitary apoplexy especially in patients with pre-existing pituitary adenoma. Physicians should be aware of this complication as it can be life threatening. A multidisciplinary team approach is recommended in treating individuals with pituitary apoplexy.

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Pituitary Apoplexy and Its Effect on Vision

Neurosurgery ◽

10.1227/00006123-199111000-00005 ◽

1991 ◽

Vol 29 (5) ◽

pp. 669-675 ◽

Cited By ~ 74

Author(s):

Robert M. McFadzean ◽

David Doyle ◽

Roy Rampling ◽

Evelyn Teasdale ◽

Graham Teasdale

Keyword(s):

Pituitary Adenoma ◽

Clinical Diagnosis ◽

Clinical Features ◽

Visual Function ◽

Pituitary Apoplexy ◽

Diagnostic Errors ◽

Large Series ◽

Ocular Motility ◽

Pathological Findings ◽

Results Of Treatment

Abstract A series of 15 patients with a clinical diagnosis of pituitary apoplexy is reviewed. Clinical features are highlighted, with stress on the defects of visual function and ocular motility, and the associated endocrine abnormalities are described. Potential diagnostic errors and their significance are considered. The incidence of this complication in a large series of pituitary adenoma patients is measured, and the radiological and pathological findings are recorded. The results of treatment by surgery and/or radiotherapy and/or bromocriptine are assessed, particularly in relation to visual consequences, and compared with previous reports in the literature, which are reviewed.

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