scholarly journals Ruptured aneurysm–induced pituitary apoplexy: illustrative case

2021 ◽  
Vol 1 (26) ◽  
Author(s):  
Michiharu Yoshida ◽  
Takeshi Hiu ◽  
Shiro Baba ◽  
Minoru Morikawa ◽  
Nobutaka Horie ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Magnetic Resonance ◽  
Vision Loss ◽  
Pituitary Apoplexy ◽  
Relevant Literature ◽  
Artery Aneurysm ◽  
Ruptured Aneurysm ◽  
Illustrative Case ◽  
Aneurysmal Rupture ◽  
Giant Pituitary Adenoma

BACKGROUND Pituitary apoplexy associated with aneurysmal rupture is extremely rare and may be misdiagnosed as primary pituitary adenoma apoplexy. The authors present a case of a patient with pituitary apoplexy caused by rupture of an anterior cerebral artery aneurysm embedded within a giant pituitary adenoma, and they review the relevant literature. OBSERVATIONS A 78-year-old man experienced sudden headache with progressive vision loss. Magnetic resonance imaging (MRI) revealed a giant pituitary tumor with abnormal signal intensity. Magnetic resonance angiography immediately before surgery showed a right A1 segment aneurysm, suggesting coexisting pituitary apoplexy and ruptured aneurysm. The patient underwent urgent transsphenoidal surgery for pituitary apoplexy. The tumor was partially removed, but the perianeurysmal component was left behind. Subsequent cerebral angiography showed a 5-mm right A1 aneurysm with a bleb that was successfully embolized with coils. Retrospective review of preoperative dynamic MRI showed extravasation of contrast medium from the ruptured aneurysm into the pituitary adenoma. Histopathologic examination showed gonadotroph adenoma with hemorrhagic necrosis. Postoperatively, the patient’s visual function improved. LESSONS MRI identification of pituitary apoplexy caused by aneurysmal rupture has not been reported previously. Aneurysmal rupture should be considered in the differential diagnosis of pituitary apoplexy. When a ruptured aneurysm is encountered, the authors recommend treating it before addressing pituitary apoplexy.

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.

scholarly journals Successful endovascular treatment of a ruptured bihemispheric posterior inferior cerebellar artery aneurysm: illustrative case

2021 ◽  
Vol 2 (7) ◽  
Author(s):  
Shingo Nishihiro ◽  
Tomotsugu Ichikawa ◽  
Yu Takahashi ◽  
Yuichi Hirata ◽  
Nobuhiko Kawai ◽  
...  
Keyword(s):  
Anatomical Variation ◽  
Posterior Inferior Cerebellar Artery ◽  
Artery Aneurysm ◽  
Ruptured Aneurysm ◽  
Cerebellar Hemisphere ◽  
Parent Artery ◽  
Illustrative Case ◽  
Related Complication ◽  
Cerebellar Artery ◽  
Sudden Headache

BACKGROUND Normal posterior inferior cerebellar artery (PICA) anatomy is highly variable, but bihemispheric PICA crossing the midline to supply the vascular territory of bilateral cerebellar hemisphere is rare. Herein, the authors reported a rare case of ruptured aneurysm that was associated with bihemispheric PICA and successfully treated endovascularly. OBSERVATIONS A 46-year-old woman presented with sudden headache and loss of consciousness because of an intraventricular hemorrhage due to a ruptured aneurysm that was associated with the bihemispheric PICA. Angiography revealed that the aneurysm was located at the bifurcation between the bihemispheric PICA and the bilateral distal PICA. The ruptured aneurysm was successfully occluded using coil embolization, which preserved the parent artery with no procedural-related complication. LESSONS To the best of the authors’ knowledge, this was the first report of a ruptured aneurysm associated with bihemispheric PICA being successfully treated endovascularly. Aneurysm formation may be accelerated by hemodynamic stress and vascular fragility. For neurosurgeons and neurointerventionalists, it is important to understand the anatomical variation of PICA, especially bihemispheric PICA, which is a potential risk factor for a fatal stroke.

scholarly journals The surgical management of pituitary apoplexy with occluded internal carotid artery and hidden intracranial aneurysm: illustrative case

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Jian-Dong Zhu ◽  
Sungel Xie ◽  
Ling Xu ◽  
Ming-Xiang Xie ◽  
Shun-Wu Xiao
Keyword(s):  
Pituitary Adenoma ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Intracranial Aneurysm ◽  
Internal Carotid ◽  
Pituitary Apoplexy ◽  
Illustrative Case ◽  
Bleeding Events ◽  
Endoscopic Endonasal ◽  
Aneurysm Embolization

BACKGROUND Approximately 0.6% to 12% of cases of pituitary adenoma are complicated by apoplexy, and nearly 6% of pituitary adenomas are comorbid aneurysms. Occlusion of the internal carotid artery (ICA) with hidden intracranial aneurysm due to compression by an apoplectic pituitary adenoma is extremely rare; thus, the surgical strategy is also unknown. OBSERVATIONS The authors reported the case of a 48-year-old man with a large pituitary adenoma with coexisting ICA occlusion. After endoscopic transnasal surgery, repeated computed tomography angiography (CTA) demonstrated reperfusion of the left ICA but with a new-found aneurysm in the left posterior communicating artery; thus, interventional aneurysm embolization was performed. With stable recovery and improved neurological condition, the patient was discharged for rehabilitation training. LESSONS For patients with pituitary apoplexy accompanied by a rapid decrease of neurological conditions, emergency decompression through endoscopic endonasal transsphenoidal resection can achieve satisfactory results. However, with occlusion of the ICA by enlarged pituitary adenoma or pituitary apoplexy, a hidden but rare intracranial aneurysm may be considered when patients are at high risk of such vascular disease as aneurysm, and gentle intraoperative manipulations are required. Performing CTA or digital subtraction angiography before and after surgery can effectively reduce the missed diagnosis of comorbidity and thus avoid life-threatening bleeding events from the accidental rupture of an aneurysm.

En Plaque Pituitary Adenoma within a Rathke's Cleft Cyst: Report of Three Cases

2017 ◽  
Vol 79 (01) ◽  
pp. 086-089
Author(s):  
Celal Iplikcioglu ◽  
Mehmet Tokmak ◽  
Erdinc Ozek ◽  
Ismail Latifaci
Keyword(s):  
Magnetic Resonance Imaging ◽  
Pituitary Adenoma ◽  
Magnetic Resonance ◽  
Pituitary Adenomas ◽  
Relevant Literature ◽  
Resonance Imaging ◽  
Rathke's Cleft Cysts ◽  
Magnetic Resonance Imaging Mri ◽  
Rathke's Cleft ◽  
Histopathologic Findings

Concomitant pituitary adenomas and Rathke's cleft cysts (RCCs) are rare. These coexisting lesions are difficult to diagnose preoperatively due to their variable signal intensity on magnetic resonance imaging (MRI) and position of the RCC. We describe three cases of coexisting pituitary adenoma and RCC, and review the relevant literature. In our cases, the RCCs were relatively large and the en plaque adenomas appeared as enhanced cyst walls on MRI examination. We also report the clinical, radiologic, surgical, and histopathologic findings of each case.

BILATERAL INTERNAL CAROTID ARTERY ANEURYSM SIMULATING PITUITARY APOPLEXY

Neurosurgery ◽  
2009 ◽  
Vol 65 (6) ◽  
pp. E1202-E1202 ◽  
Author(s):  
Alberto Torres ◽  
Ruben Dammers ◽  
Ali F. Krisht
Keyword(s):  
Breast Cancer ◽  
Pituitary Adenoma ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Internal Carotid ◽  
Pituitary Apoplexy ◽  
Sella Turcica ◽  
Metastatic Breast ◽  
Artery Aneurysm ◽  
Vascular Lesion

Abstract OBJECTIVE Intracavernous internal carotid artery (ICA) aneurysms can extend into the sella and simulate pituitary adenomas. However, they are rarely associated with pituitary apoplexy. We present a rare case of bilateral intracavernous ICA aneurysms simulating a sellar mass with the clinical picture of a pituitary apoplexy. CLINICAL PRESENTATION An 82-year-old woman presented with a classic case of pituitary apoplexy with a history of headache, nausea, vomiting, and diplopia. She was found to have an intrasellar mass simulating a large and invasive pituitary adenoma. The patient had a medical history positive for breast cancer. INTERVENTION Because of the presentation with apoplexy and the possibility of metastatic breast cancer or pituitary adenoma, the patient was explored transsphenoidally to obtain pathological verification and possibly resect the tumor. Unusual intraoperative findings led to a microDoppler evaluation, suggesting a vascular lesion. Intraoperatively, an angiogram confirmed the presence of bilateral ICA giant aneurysms involving the ICA intracavernous component extending into the sella turcica. The patient refused further treatment. CONCLUSION The present case indicates that an intrasellar ICA aneurysm can be misdiagnosed as a macroadenoma and even present through pituitary apoplexy. When treating intrasellar masses with the slightest suspicion of a nonpituitary origin, further workup should be considered. The possibility of a vascular lesion simulating a pituitary adenoma should always be considered by neurosurgeons and ear, nose, and throat surgeons operating in the sellar region.

scholarly journals Acute Lymphoblastic Leukemia Presenting as Pituitary Apoplexy: A Case Report and Review of the Literature

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Rahul Gupta ◽  
Urmimala Bhattacharjee ◽  
K. S. Lekshmon ◽  
Shakun Chaudhary ◽  
Prashant Sharma ◽  
...  
Keyword(s):  
Acute Lymphoblastic Leukemia ◽  
Pituitary Adenoma ◽  
Vision Loss ◽  
Pituitary Apoplexy ◽  
Haematological Malignancy ◽  
Lymphoblastic Leukemia ◽  
Rare Event ◽  
Acinetobacter Baumanii ◽  
Current Case ◽  
Lymphoid Leukemia

Thrombocytopenia as a precipitating factor for pituitary apoplexy (PA) is very rare event. There are only five reported cases of PA secondary to thrombocytopenia caused by underlying haematological malignancy. Herein, we report a case of 60-year-old male presenting with acute-onset headache, bilateral vision loss, and ptosis. Computed tomography and magnetic resonance imaging revealed findings indicative of pituitary adenoma with apoplexy. He was noted to have thrombocytopenia, and bone marrow evaluation revealed precursor B-lineage CALLA-positive acute lymphoblastic leukemia. Accordingly, he was started on dexamethasone and vincristine but succumbed to Acinetobacter baumanii-related hospital-acquired pneumonia two weeks after initiation of chemotherapy. We performed a literature search and found five cases of pituitary apoplexy secondary to haematological malignancy-related thrombocytopenia. The usual age of presentation was in the 6th to 7th decade, and there was slight male preponderance. The underlying pituitary adenoma was either nonfunctioning or a prolactinoma, and in majority, the apoplexy event occurred after the diagnosis of haematological malignancy. The platelet counts at the time of PA were less than 30 × 109/L in all, and the malignancy subtypes were acute or chronic myeloid leukemia and chronic lymphoid leukemia. The current case highlights the importance of careful evaluation for the cause of thrombocytopenia in a case of PA.

scholarly journals Failed endovascular therapy for acute internal carotid artery occlusion from pituitary apoplexy: illustrative case

2021 ◽  
Vol 2 (10) ◽  
Author(s):  
Marwah A. Elsehety ◽  
Hussein A. Zeineddine ◽  
Andrew D. Barreto ◽  
Spiros L. Blackburn
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Acute Stroke ◽  
Balloon Angioplasty ◽  
Vision Loss ◽  
Internal Carotid ◽  
Pituitary Apoplexy ◽  
Surgical Removal ◽  
Illustrative Case

BACKGROUND Large pituitary adenomas can rarely cause compression of the cavernous internal carotid artery (ICA) due to chronic tumor compression or invasion. Here, the authors present a case of pituitary apoplexy causing acute bilateral ICA occlusion with resultant stroke. Our middle-aged patient presented with sudden vision loss and experienced rapid deterioration requiring intubation. Computed tomography (CT) angiography revealed a large pituitary mass causing severe stenosis of the bilateral ICAs. CT perfusion revealed a significant perfusion delay in the anterior circulation. The patient was taken for cerebral angiography, and balloon angioplasty was attempted with no improvement in arterial flow. Resection of the tumor was then performed, with successful restoration of blood flow. Despite restoration of luminal patency, the patient experienced bilateral ICA infarcts. OBSERVATIONS Pituitary apoplexy can present as an acute stroke due to flow-limiting carotid compression. Balloon angioplasty is ineffective for the treatment of this type of compression. Surgical removal of the tumor restores the flow and luminal caliber of the ICA. LESSONS Pituitary apoplexy can be a rare presentation of acute stroke and should be managed with immediate surgical decompression rather than attempted angioplasty in order to restore blood flow and prevent the development of cerebral ischemia.

Evaluation of Fine Feeding System and Angioarchitecture of Giant Pituitary Adenoma

2016 ◽  
Vol 77 (S 02) ◽  
Author(s):  
Yoshikazu Ogawa ◽  
Kenichi Sato ◽  
Yasushi Matsumoto ◽  
Teiji Tominaga
Keyword(s):  
Pituitary Adenoma ◽  
Feeding System ◽  
Giant Pituitary Adenoma
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