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 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 Left internal carotid artery agenesis in a patient with headache

2014 ◽  
pp. 25-27
Author(s):  
Inês Alice Teixeira Leão ◽  
C. H. Rezende ◽  
J. B. L. Gomes ◽  
R. F. Almeida
Keyword(s):  
Computed Tomography ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Rare Case ◽  
Internal Carotid ◽  
Left Internal Carotid Artery ◽  
Left Middle Cerebral Artery ◽  
Clinical Neurology ◽  
Structural Lesion ◽  
Left Middle

Sometimes in clinical neurology, we diagnose a very rare case. We report on a patient who presented with crisis of headache and vomiting (clinically diagnose as migraine). Computed tomography (CT) scan of the head did not reveal any structural lesion. Magnetic resonance angiography showed absence of left internal carotid artery associated with absence of the left middle cerebral artery (MCA).

scholarly journals Hyponatremia as the Initial Presentation of Evolving Pituitary Apoplexy

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A586-A586
Author(s):  
Jovan Milosavljevic ◽  
Asha Mary Thomas
Keyword(s):  
Mental Status ◽  
Pituitary Apoplexy ◽  
Pituitary Tumors ◽  
Altered Mental Status ◽  
Clinical Syndrome ◽  
Medical Emergency ◽  
Fluid Restriction ◽  
Free T4 ◽  
Acute Hemorrhage ◽  
Initial Testing

Abstract Pituitary apoplexy (PA) is a known, often under-recognized medical emergency and is characterized by ischemic or hemorrhagic necrosis of the pituitary gland. It is a rare clinical syndrome that occurs in 2-12% of pituitary tumors. Hyponatremia can occur secondary to hypocortisolism (12-40%) or, rarely, to the syndrome inappropriate antidiuretic hormone (ADH) secretion. We present the case of a 69-year-old man who presented with altered mental status on post-operative day 3 from total knee replacement surgery. Initial testing revealed hyponatremia of 124 mmol/L, low serum osmolality of 266 mOsm/kg, and high urine osmolality of 664 mOsm/kg with urine sodium of 179 mmol/L. Head computerized tomography revealed a sellar mass of 1.8 x 2.4 cm. Initial testing revealed low prolactin (0.7 ng/mL), normal TSH (0.458 mcIU/mL) with borderline low free T4 of 0.72 ng/dL. Morning cortisol was 12.7 mcg/dL with ACTH of 8.5 pg/mL. Cosyntropin stimulation test was done revealing baseline cortisol of 5.8 mcg/dL (at midnight), increasing to 25.8 mcg/dL after 30 minutes and to 30.9 mcg/dL 60 minutes after cosyntropin administration. His sodium and mental status initially improved with fluid restriction and salt tablets, for the assumed syndrome of inappropriate ADH secretion. The patient remained hemodynamically stable. On the fourth day, however, his mental status deteriorated. Magnetic resonance imaging revealed expansion of sella with hyperintense mass 2.2 x 2.0 x 2.8 cm with compression of the optic chiasm. He was given stress dose hydrocortisone and levothyroxine and underwent emergency transsphenoidal resection. Biopsy revealed acute hemorrhage within infarcted adenoma. Postoperatively, both the patient’s sodium and mental status improved significantly and he was discharged to home on hydrocortisone and levothyroxine. The main clinical concern in the management of PA remains under-diagnosis at presentation. Prognosis is dependent on management during the acute phase. PA can present as hyponatremia even in the absence of overt hypocortisolism, presumably due to inappropriate ADH secretion. Therefore, PA should be considered as one of the differential diagnoses in hemodynamically stable patients with altered mental status and hyponatremia.

scholarly journals Acute Ischaemic Stroke Successfully Treated with Thrombolytic Therapy and Endovascular Thrombectomy with Non-Contrast Computed Tomography and Computed Tomography Angiogram Protocol

2020 ◽  
Vol 12 (Suppl. 1) ◽  
pp. 15-21
Author(s):  
Tsun-Haw Toh ◽  
Khairul Azmi Abdul Kadir ◽  
Mei-Ling Sharon Tai ◽  
Kay Sin Tan
Keyword(s):  
Computed Tomography ◽  
Signs And Symptoms ◽  
Left Internal Carotid Artery ◽  
Left Middle Cerebral Artery ◽  
Endovascular Thrombectomy ◽  
Nihss Score ◽  
Ct Angiogram ◽  
Improved Outcomes ◽  
Computed Tomography Angiogram ◽  
Left Middle

Early endovascular thrombectomy leads to improved outcomes for patients with proximal occlusions when started within 6 h from onset of symptoms. We present a case illustrating the flow of events for a patient who underwent endovascular thrombectomy in our centre after conventional imaging – a brain non-contrast computed tomography (NCCT) and CT angiogram (CTA) – achieving a door-to-groin time of 195 min. The patient is a 65-year-old who presented with signs and symptoms of a left middle cerebral artery (MCA) territory infarct. His National Institute of Health Stroke Scale (NIHSS) score was 15 on presentation and his brain NCCT showed an Alberta Stroke Programme Early CT Score (ASPECTS) of 8. His CTA showed a left MCA distal M1 occlusion with focal calcification and stenosis of the proximal left internal carotid artery. He was subsequently thrombosed and underwent thrombectomy successfully, with a door-to-groin-puncture time of 195 min. A TICI 2b reperfusion was achieved. His NIHSS score improved to 9 over the next 2 days. For cases with straightforward NCCT and CTA with no contraindications, endovascular thrombectomy should be pursued without delay. A review of the current available literature for the usage of NCCT and CTA as well as the importance of ASPECTS scoring in patient selection for endovascular thrombectomy was included.

scholarly journals Pituitary apoplexy accompanying temporal lobe epilepsy as a complication: case report

2019 ◽  
Author(s):  
Katsunori Shijo ◽  
Sodai Yoshimura ◽  
Fumi Mori ◽  
Shun Yamamuro ◽  
Koichiro Sumi ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Pituitary Apoplexy ◽  
Rare Complication ◽  
Cranial Nerves ◽  
Clinical Manifestations ◽  
Clinical Syndrome ◽  
Healthy Male ◽  
Case Presentation

Abstract Background : Pituitary apoplexy is an acute clinical syndrome caused by infarction and/or hemorrhage of pituitary adenoma, which typically presents with severe headache, visual deterioration, and endocrine abnormalities. However, temporal lobe epileptic seizure has not been viewed as a symptom of pituitary apoplexy in the literature. Case presentation : To elucidate further such a rare complication of temporal lobe epilepsy-like seizure, we describe here the rare clinical manifestations of a 55-year-old previously healthy male with pituitary apoplexy harboring headache, combined palsies involving cranial nerves III to VI, endocrinologic disturbances, and temporal lobe epilepsy-like seizure. In addition, we discuss the temporal lobe epilepsy associated with pituitary adenoma based on the literature. Conclusion : Although further accumulation of clinical data is needed, we would like to emphasize the importance of recognition of temporal lobe epilepsy-like seizure due to pituitary apoplexy, and to suggest that early surgery should be considered as an option in patients displaying such a rare complication.

scholarly journals Pituitary Adenoma in the Elderly

2021 ◽  
Vol 8 (05) ◽  
pp. 01-07
Author(s):  
Atroune L
Keyword(s):  
Pituitary Adenoma ◽  
Surgical Planning ◽  
Average Duration ◽  
Clinical Signs ◽  
Pituitary Tumors ◽  
The Elderly ◽  
Duration Of Symptoms ◽  
Radiological Data ◽  
Wide Availability ◽  
Neuro Imaging

Given advances and wide availability of neuroimaging coupled with longer life span, higher numbers of elderly patients with pituitary adenomas are being seen who are potential surgical or medical therapy candidates. Our study concerns 07 cases of Pituitary adenoma in patients aged more than 70 years old, collected in Mustapha Pasha’s neurosurgery department in Algiers for a period of 18 years (from 2000 to 2018). Pituitary adenoma is not considered a disease of advanced age; its incidence is rated around 3–4%. The average age of patients was 72 years old, slightly more common in females and represents 60% of the cases. The average duration of symptoms before diagnosis is 2 and half years. The clinical signs were dominated by visual deterioration, and in a lesser degree a hypopituitarism. Neuro-imaging (CT scan/ MRI) are the key exams. MRI is important especially in the development of surgical planning. Collected radiological data reported the presence of macro adenoma with supra sellar extension in the majority of our cases; The surgical approach was transnasal- Transsphenoidal in all patients. The evolution was satisfactory for the majority of patients. However, complications were noted. We deplore the death of a patient presented with meningitis. Patients over age 70 with pituitary tumors and indications for surgery should be considered surgical candidates for transsphenoidalsurgery given the low risks of this procedure.

scholarly journals RECURRENT PITUITARY APOPLEXY IN AN ADENOMA WITH SWITCHING PHENOTYPES

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.

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.

Pituitary apoplexy accompanying temporal lobe epilepsy as a complication: case report

2019 ◽  
Author(s):  
Katsunori Shijo ◽  
Sodai Yoshimura ◽  
Fumi Mori ◽  
Shun Yamamuro ◽  
Koichiro Sumi ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Temporal Lobe Epilepsy ◽  
Temporal Lobe ◽  
Pituitary Apoplexy ◽  
Rare Complication ◽  
Cranial Nerves ◽  
Clinical Manifestations ◽  
Clinical Syndrome ◽  
Healthy Male ◽  
Case Presentation

Abstract Abstract Background: Pituitary apoplexy is an acute clinical syndrome caused by infarction and/or hemorrhage of pituitary adenoma, which typically presents with severe headache, visual deterioration, and endocrine abnormalities. However, temporal lobe epileptic seizure has not been viewed as a symptom of pituitary apoplexy in the literature. Case presentation: To elucidate further such a rare complication of temporal lobe epilepsy, we describe here the rare clinical manifestations of a 55-year-old previously healthy male with pituitary apoplexy harboring headache, combined palsies involving cranial nerves III to VI, endocrinologic disturbances, and temporal lobe epilepsy. In addition, we discuss the temporal lobe epilepsy of pituitary adenoma based on the literature. Conclusion: Although further accumulation of clinical data is needed, we would like to emphasize the importance of recognition of temporal lobe epilepsy due to pituitary apoplexy, and suggest that early surgery should be considered as an option in patients with such a rare complication.

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