Pituitary Apoplexy and Its Effect on Vision

Neurosurgery ◽  
1991 ◽  
Vol 29 (5) ◽  
pp. 669-675 ◽  
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.

scholarly journals Pituitary adenoma apoplexy

2017 ◽  
Vol 95 (2) ◽  
pp. 177-180
Author(s):  
Irina V. Tereshchenko
Keyword(s):  
Risk Factors ◽  
Pituitary Adenoma ◽  
Young Women ◽  
Pituitary Apoplexy ◽  
Clinical Presentation ◽  
Diagnostic Errors

We present 3 cases of pituitary adenoma apoplexy in young women (one microadenoma and two macroadenomas). The possible risk factors, clinical presentation and outcome of pituitary apoplexy are discussed. Diagnostic errors as regards pituitary adenoma apoplexy are analyzed.

scholarly journals Management and outcomes of pituitary apoplexy

2015 ◽  
Vol 122 (6) ◽  
pp. 1450-1457 ◽  
Author(s):  
Tarun D. Singh ◽  
Navid Valizadeh ◽  
Fredric B. Meyer ◽  
John L. D. Atkinson ◽  
Dana Erickson ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Functional Outcomes ◽  
Pituitary Apoplexy ◽  
Histopathological Examination ◽  
Visual Fields ◽  
Visual Field Defects ◽  
Ocular Motility ◽  
Cranial Nerve Palsies

OBJECT This study was undertaken to analyze the predisposing factors, clinical presentation, therapeutic management, and clinical recovery in patients with pituitary apoplexy, with an emphasis on the long-term visual, endocrine, and functional outcomes. METHODS The authors performed a retrospective analysis of consecutive cases involving patients treated at Mayo Clinic between 1992 and 2013. Patients were included in the study only if they had 1) abrupt onset of severe headache or visual disturbance in the presence of a pituitary adenoma and 2) radiological or surgical confirmation of a pituitary mass. The primary endpoints of analysis were the visual (ocular motility, visual fields, and visual acuity), endocrine, and functional outcomes (using the modified Rankin Scale). RESULTS Eighty-seven patients were identified (57 males and 30 females, mean age 50.9 years, range 15–91 years). Twenty-two patients (25.3%) had a known pituitary adenoma. Hypertension was the most common associated factor (39%). Headache was the most frequent presenting symptom (89.7%), followed by visual abnormalities (47.1%). Cranial nerve palsies were present in 39% and visual field defects in 34.1%. MRI detected hemorrhage in 89% patients, as compared with 42% detected by CT scan. Sixty-one patients (70.1%) underwent surgery during acute hospitalization (median time from apoplexy 5 days, IQR 3–10 days), 8 (9.2%) had delayed surgery, and 18 (20.7%) were treated conservatively. Histopathological examination revealed adenoma with pure necrosis in 18 (30%), pure hemorrhage in 4 (6.7%), and both in 6 (10%) patients. Four patients died during hospitalization. The average duration of follow-up was 44.2 ± 43.8 months. All survivors were independent and had complete resolution or substantial improvement in eye movements and visual fields at the last follow-up. Many patients needed long-term hormonal replacement with levothyroxine (62.7%) and cortisol (60%). Daily desmopressin was needed in 23% of all surgical patients at 3 months (versus none of the medically treated) and this requirement decreased slightly over time. Regrowth of pituitary adenoma was seen in 7 patients (8.6%). There were no statistically significant differences in any of the outcome measures across the treatment groups. CONCLUSIONS The outcome of most patients with pituitary apoplexy is excellent. Selected patients can be managed conservatively, and patients with severe neuro-ophthalmological deficits treated with early surgery can achieve an excellent recovery.

scholarly journals A Decrease In Visual Acuity Revealing A Pituitary Apoplexy

2020 ◽  
Vol 2 (3) ◽  
Author(s):  
Joumany Brahim Salem ◽  
Sidi Dahi ◽  
Mahdi Khammaily ◽  
Wafa Akioud ◽  
Yassine Mouzari ◽  
...  
Keyword(s):  
Visual Acuity ◽  
Pituitary Adenoma ◽  
Pituitary Apoplexy ◽  
Ocular Motility ◽  
Light Perception ◽  
Sudden Decrease ◽  
The Right ◽  
Acute Headache ◽  
The Brain ◽  
Decrease In Visual Acuity

Pituitary apoplexy is caused by an infarction or a hemorrhage in a pituitary adenoma. It is a very serious but rare accident. We present the case of a 28-year-old patient with no specific history who had experienced severe acute headache and a sudden decrease in visual acuity. Clinical examination showed a VA with negative light perception on the right and 1/10 on the left , bilateral aréflective mydriasis ODG, ocular motility preserved bilaterally, with normal FO in both eyes. An emergency CT scan of the brain reveals a giant intra-sellar pituitary adenoma and a hemorrhagic area in it’s center evoking a picture of pituitary apoplexy.

Cataract. Diagnostic errors at referring patients to surgery

2020 ◽  
Author(s):  
V.V. Egorov ◽  
◽  
E.L. Sorokin ◽  
G.P. Smoliakova ◽  
O. V. Kolenko ◽  
...  
Keyword(s):  
Clinical Diagnosis ◽  
Diagnostic Errors ◽  
Ophthalmological Examination ◽  
Slit Lamp ◽  
Critical View ◽  
Optical Media

The textbook examines the most common diagnostic errors of ophthalmologists when making a clinical diagnosis of "cataract". Clinical examples point to a more critical view of the cataract diagnosis. Due to the fact that most of the errors are based on a superficial examination of the eye, clear recommendations are given for conducting a clinical ophthalmological examination of cataracts. At the same time, special attention is paid to the types of examination of the lens with the help of a slit lamp, to the peculiarities of performing various types of ophthalmoscopy with moderate opacity of optical media.

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

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.

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.

STUDIES OF STABLE IODINE METABOLISM AS A GUIDE TO THE INTERPRETATION OF RADIOIODINE TESTS

1961 ◽  
Vol 37 (4) ◽  
pp. 597-606 ◽  
Author(s):  
D. A. Koutras ◽  
W. D. Alexander ◽  
W. W. Buchanan ◽  
J. Crooks ◽  
E. J. Wayne
Keyword(s):  
Clinical Features ◽  
Thyroid Function ◽  
Clinical Picture ◽  
Diagnostic Errors ◽  
Previous Treatment ◽  
The Body ◽  
High Uptake ◽  
Iodine Metabolism ◽  
Inorganic Iodine ◽  
Stable Iodine

ABSTRACT The results of radioiodine tests are dependent not only on thyroid function but also on the size of the iodine pools in which the radioiodine is diluted. The significance of the second factor is analysed in this paper and it is shown that there is a danger in interpreting radioiodine tests in isolation. The uptake of 131I is inversely related to the extrathyroidal inorganic iodine pool and the PB131I is inversely related to the intrathyroidal iodine pool. Both these pools may be diminished in euthyroid persons and thus a high uptake of 131I may be associated with a high PB131I and so lead to false diagnostic conclusions. In order to avoid diagnostic errors standard 131I tests should never be reported without some knowledge of relevant clinical features, for example, whether there is the possibility of prolonged iodine deficiency, of previous treatment, of Hashimoto's disease, or of dyshormonogenesis. In this way due weight can be given to factors which increase or decrease the iodine pools of the body and discrepancies between the clinical picture and radioiodine tests become obvious. More specific investigations can then be undertaken in appropriate cases.

scholarly journals Spinal Subdural Hematoma in Association with Anticoagulant Therapy

1981 ◽  
Vol 8 (1) ◽  
pp. 87-89 ◽  
Author(s):  
Neville Russell ◽  
F.B. Maroun ◽  
J.C. Jacob
Keyword(s):  
Spinal Cord ◽  
Clinical Features ◽  
Anticoagulant Therapy ◽  
Spinal Cord Compression ◽  
Subdural Hematoma ◽  
Cord Compression ◽  
Ischemic Necrosis ◽  
Results Of Treatment ◽  
Spinal Subdural Hematoma

SUMMARYA case of spinal subdural hematoma occurring in association with anticoagulant therapy is reported. Seven similar cases from the literature are reviewed with emphasis on the clinical features, investigation, and the results of treatment. The prognosis for recovery is good, only if the condition is diagnosed and the clot evacuated before severe spinal cord compression and subsequent ischemic necrosis has occurred.

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