Pituitary adenoma apoplexy

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

Case Reports in Internal Medicine ◽

10.5430/crim.v4n1p21 ◽

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.

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

Arquivos Brasileiros de Neurocirurgia Brazilian Neurosurgery ◽

10.1055/s-0037-1608907 ◽

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.

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Pituitary apoplexy: re-evaluation of risk factors for bleeding into pituitary adenomas and impact on outcome

Acta Endocrinologica ◽

10.1530/eje-10-0651 ◽

2011 ◽

Vol 164 (1) ◽

pp. 37-43 ◽

Cited By ~ 69

Author(s):

Diane L Möller-Goede ◽

Michael Brändle ◽

Klara Landau ◽

Rene L Bernays ◽

Christoph Schmid

Keyword(s):

Risk Factors ◽

Pituitary Adenoma ◽

Antithrombotic Therapy ◽

Pituitary Apoplexy ◽

Tumour Size ◽

Visual Field Defects ◽

Control Group ◽

Potential Risk Factors ◽

Male Sex ◽

Insight Into

ObjectiveTo assess frequency, symptoms and outcome of pituitary apoplexy (PA) among pituitary adenoma patients, to gain better insight into risk factors for bleeding into pituitary adenoma and to estimate the sequelae of PA by means of a matched control group.MethodBy reviewing charts of 574 patients with pituitary adenoma, we analysed incidence, symptoms and outcome of PA and potential risk factors for developing PA by means of a control group (patients with pituitary adenoma without PA).ResultsIn total, 42 suffered from PA, all had macroadenomas; 30/217 male (14%) and 12/179 female (7%) macroadenoma patients, 32/194 patients with clinically non-functioning (16.5%) and 10/202 with clinically active (5.0%) macroadenoma were affected. Antithrombotic therapy predisposed patients to PA (P=0.026), diabetes mellitus and hypertension did not (P=1.00). Patients with PA and pituitary adenoma patients without PA had similar frequencies of hypopituitarism (45 vs 48%,P>0.05) and visual field defects (38 vs 55%,P>0.05), but ophthalmoplegia was significantly more common (76 vs 5%,P<0.001) in patients with PA. Nearly all patients were treated by surgery; most recovered from ophthalmoplegia, whereas visual function improved only moderately. Endocrine outcome was worse in patients with PA than in patients without PA.ConclusionsMale sex and characteristics of the adenoma itself (especially tumour size and tumour type) rather than patient's cardiovascular risk factors such as diabetes and hypertension seem to predispose to PA; antithrombotic therapy may also be important.

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Pituitary Apoplexy: A Rare Cause of Cerebral Infarction

The Neuroradiology Journal ◽

10.1177/197140090802100509 ◽

2008 ◽

Vol 21 (5) ◽

pp. 661-665 ◽

Cited By ~ 6

Author(s):

A. Ben-Nakhi ◽

T.J.E. Muttikkal ◽

V.N.K. Chavan ◽

A. Yt Al-Turkomani ◽

R. Gupta

Keyword(s):

Pituitary Adenoma ◽

Cerebral Ischemia ◽

Sudden Death ◽

Cerebral Infarction ◽

Pituitary Apoplexy ◽

Clinical Presentation ◽

Mass Effect ◽

Mechanical Obstruction ◽

Hemorrhagic Infarction

Pituitary apoplexy is usually the result of hemorrhagic infarction in pituitary adenoma. The clinical presentation of pituitary apoplexy varies widely and includes asymptomatic hemorrhage, classical pituitary apoplexy and even sudden death. Few cases of cerebral infarction associated with pituitary apoplexy have been reported in the literature. Pituitary apoplexy can cause narrowing of intracranial vessels by mechanical obstruction due to mass effect or by vasospasm resulting in cerebral ischemia. We report a case of pituitary apoplexy associated with cerebral infarction and the putative mechanisms.

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Incidence of Pituitary Apoplexy and Its Risk Factors in Chinese People: A Database Study of Patients with Pituitary Adenoma

PLoS ONE ◽

10.1371/journal.pone.0139088 ◽

2015 ◽

Vol 10 (9) ◽

pp. e0139088 ◽

Cited By ~ 13

Author(s):

Xiaoming Zhu ◽

Yongfei Wang ◽

Xuelan Zhao ◽

Cuiping Jiang ◽

Qiongyue Zhang ◽

...

Keyword(s):

Risk Factors ◽

Pituitary Adenoma ◽

Pituitary Apoplexy ◽

Chinese People ◽

Database Study

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Rathke cleft cyst apoplexy: Hormonal and clinical presentation

Surgical Neurology International ◽

10.25259/sni_382_2021 ◽

2021 ◽

Vol 12 ◽

pp. 504

Author(s):

Turki Elarjani ◽

Meshari Rashed Alhuthayl ◽

Mahammad Dababo ◽

Imad N Kanaan

Keyword(s):

Pituitary Adenoma ◽

English Language ◽

Pituitary Apoplexy ◽

Clinical Presentation ◽

Hormonal Status ◽

Current Management ◽

Management Guidelines ◽

Rathke Cleft Cyst ◽

Good Number

Background: Rathke cleft cyst (RCC) apoplexy is an uncommon type of lesion that is challenging to diagnose without histopathological samples. Very few articles have been published describing the details of RCC apoplexy. We studied a good number of published articles to analyze its demographics, clinical and hormonal presentations, and outcomes. Methods: A literature review of English language publications about RCC apoplexy or pituitary apoplexy was conducted using Medline and EMBASE search engines. Thirty articles with histological diagnosis of RCC apoplexy were identified, the earliest of which was published in 1990 and the latest in 2019. We combined the findings of these articles with our own case report and then compared the demographics, clinical and hormonal presentations, and outcomes between RCC apoplexy and pituitary adenoma apoplexy. Results: Our data included 29 patients with RCC, with a mean age of 36.87 years (8–72) and a predominance of female patients (68%). The hemorrhagic type was most common, reported in 86%. Headache was the most common presenting symptom, being reported in 93% followed by hypogonadism (73%) and hormonal deficits (52%). All but three patients improved neurologically (90%); however, 45% of patients required long-term hormonal replacement, mostly thyroid hormone. No cases of worsening neurological or hormonal status were reported. Conclusion: RCC apoplexy presents with less severe neurological and hormonal abnormalities than pituitary adenoma apoplexy; it also has a better prognosis in endocrine functional recovery. We recommend applying current management guidelines of pituitary adenoma apoplexy to RCC apoplexy.

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