scholarly journals Acute pituitary apoplexy complicating a pituitary macroadenoma

2010 ◽  
Vol 14 (4) ◽  
pp. 118
Author(s):  
Febin Joseph ◽  
Zarina I Lockhat ◽  
Malan Janse van Rensburg ◽  
Janet Smal ◽  
Tshepo Peter Moja
Keyword(s):  
Pituitary Gland ◽  
Pituitary Apoplexy ◽  
Clinical Syndrome ◽  
Pituitary Macroadenoma ◽  
Altered State ◽  
Visual Defects ◽  
Threatening Condition ◽  
Life Threatening ◽  
Altered State Of Consciousness

Pituitary apoplexy is a rare but potentially life-threatening condition caused by either haemorrhage or infarction of the pituitary gland. In most cases, a pre-existing pituitary macroadenoma is present. Patients present with the clinical syndrome of headache, visual defects or ophthalmoplegia, altered state of consciousness and variable endocrine deficits.

scholarly journals Risk stratification in cardiogenic shock: a focus on the available evidence

2021 ◽  
Author(s):  
C. Sciaccaluga ◽  
G. E. Mandoli ◽  
N. Ghionzoli ◽  
F. Anselmi ◽  
C. Sorini Dini ◽  
...  
Keyword(s):  
Risk Stratification ◽  
Cardiogenic Shock ◽  
Clinical Syndrome ◽  
Diagnostic Assessment ◽  
Prognostic Scores ◽  
Current Evidence ◽  
Efficient Resource ◽  
Threatening Condition ◽  
Life Threatening ◽  
Future Direction

AbstractCardiogenic shock is a clinical syndrome which is defined as the presence of primary cardiac disorder that results in hypotension together with signs of organ hypoperfusion in the state of normovolaemia or hypervolaemia. It represents a complex life-threatening condition, characterized by a high mortality rate, that requires urgent diagnostic assessment as well as treatment; therefore, it is of paramount important to advocate for a thorough risk stratification. In fact, the early identification of patients that could benefit the most from more aggressive and invasive approaches could facilitate a more efficient resource allocation. This review attempts to critically analyse the current evidence on prognosis in cardiogenic shock, focusing in particular on clinical, laboratoristic and echocardiographic prognostic parameters. Furthermore, it focuses also on the available prognostic scores, highlighting the strengths and the possible pitfalls. Finally, it provides insights into future direction that could be followed in order to ameliorate risk stratification in this delicate subset of patients.

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.

scholarly journals Multidisciplinary Management of Pituitary Apoplexy

2016 ◽  
Vol 2016 ◽  
pp. 1-11 ◽  
Author(s):  
Adriana Albani ◽  
Francesco Ferraù ◽  
Filippo Flavio Angileri ◽  
Felice Esposito ◽  
Francesca Granata ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Pituitary Gland ◽  
Multidisciplinary Approach ◽  
Pituitary Apoplexy ◽  
Clinical Syndrome ◽  
Surgical Decompression ◽  
Medical Emergency ◽  
Multidisciplinary Management ◽  
Pituitary Tumours ◽  
Haemorrhagic Necrosis

Pituitary apoplexy is a rare clinical syndrome due to ischemic or haemorrhagic necrosis of the pituitary gland which complicates 2–12% of pituitary tumours, especially nonfunctioning adenomas. In many cases, it results in severe neurological, ophthalmological, and endocrinological consequences and may require prompt surgical decompression. Pituitary apoplexy represents a rare medical emergency that necessitates a multidisciplinary approach. Modalities of treatment and times of intervention are still largely debated. Therefore, the management of patients with pituitary apoplexy is often empirically individualized and clinical outcome is inevitably related to the multidisciplinary team’s skills and experience. This review aims to highlight the importance of a multidisciplinary approach in the management of pituitary apoplexy and to discuss modalities of presentation, treatment, and times of intervention.

scholarly journals Pituitary Apoplexy: A Retrospective Study of 33 Cases From a Single Center

2021 ◽  
Vol 12 ◽  
Author(s):  
Henrik Falhammar ◽  
Sofia Tornvall ◽  
Charlotte Höybye
Keyword(s):  
Pituitary Apoplexy ◽  
Pituitary Surgery ◽  
University Hospital ◽  
Single Center ◽  
Precipitating Factors ◽  
Threatening Condition ◽  
Life Threatening ◽  
Inhomogeneous Condition ◽  
Neurosurgical Intervention

PurposeAcute symptomatic pituitary apoplexy is a rare and potentially life-threatening condition. However, pituitary apoplexy can also present with milder symptoms and stable hemodynamics. Due to the rarity of this inhomogeneous condition, clinical studies are important to increase the knowledge.MethodsWe retrospectively reviewed all consecutive cases of pituitary apoplexy being admitted between January 1st, 2005 and December 31st, 2019 at the Karolinska University Hospital, Stockholm, Sweden, for symptoms, results of magnetic resonance (MRI), biochemistry, management and mortality.ResultsThirty-three patients were identified with pituitary apoplexy, 18 were men (55%) and mean age was 46.5 (17.2) years. The incidence of symptomatic pituitary apoplexy was 1.6 patients/year (0.76 patients/1,000,000 inhabitants/year). The majority presented with headache (n=27, 82%) and hormonal deficiencies (n=18, 55%), which were most frequent in men. ACTH deficiency was present in nine patients (27% but 50% of those with hormonal deficiencies). All had the characteristic findings on MRI. Only three patients (9%) required acute pituitary surgery, while eight were operated after more than one week. Seven (21%) were on antithrombotic therapy. None of the patients died in the acute course. During follow-up (7.6 ± 4.3 years) none of the hormonal deficiencies regressed and 3 patients died from non-related causes.ConclusionOur study confirmed the rarity and the symptoms of this condition. Surprisingly, only 3 patients needed acute neurosurgical intervention, perhaps due to milder cases and a general intensified treatment of precipitating factors. An early awareness and in severe cases decision on pituitary surgery is of utmost importance to avoid severe complications.

scholarly journals Rhabdomyolysis-Induced Acute Kidney Injury in Diabetic Emergency: Underdiagnosed and an Important Association to Be Aware of

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Ami Amin ◽  
Bhavika Gandhi ◽  
Steven Torre ◽  
Alireza Amirpour ◽  
Jennifer Cheng ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Diabetic Ketoacidosis ◽  
Clinical Manifestations ◽  
Kidney Injury ◽  
Clinical Syndrome ◽  
Dark Urine ◽  
Threatening Condition ◽  
Hyperosmolar Hyperglycemic State ◽  
Life Threatening ◽  
Electrolyte Abnormalities

Rhabdomyolysis is a potentially life-threatening clinical syndrome associated with muscle injury which can cause a leakage of intracellular contents, manifested from the range of being asymptomatic to a life-threatening condition causing acute kidney injury and severe electrolyte abnormalities. Rhabdomyolysis has been associated with both diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome, though there is an increased association with rhabdomyolysis and acute kidney injury with hyperosmolar nonketonic state compared with patients with diabetic ketoacidosis. Common clinical manifestations are muscle pain, dark urine, and generalized weakness. The causes of rhabdomyolysis are broadly categorized into three groups: traumatic, nontraumatic exertional, and nontraumatic nonexertional. Here, we present a case of rhabdomyolysis-induced acute kidney injury in a patient with hyperosmolar hyperglycemic state. The patient was discharged on insulin and needed intermittent dialysis for two months. Our case highlights the importance of the rare association of rhabdomyolysis causing acute kidney injury in a diabetic emergency.

scholarly journals Coronavirus Disease 2019 (Covid-19) Outbreak and Pituitary Apoplexy

2021 ◽  
Author(s):  
Rafael Martinez-Perez ◽  
Benjamin W Carroll ◽  
Daniel Duran ◽  
James S Neill ◽  
Gustavo D Luzardo ◽  
...  
Keyword(s):  
Pituitary Adenoma ◽  
Molecular Mechanisms ◽  
Pituitary Apoplexy ◽  
Care Center ◽  
Tertiary Care ◽  
Perioperative Period ◽  
Common Symptom ◽  
Increased Risk ◽  
Threatening Condition ◽  
Life Threatening

Abstract Background. Pituitary apoplexy (PA) is a rare and potentially life-threatening condition characterized by pituitary hemorrhage, often in the setting of a preexisting pituitary adenoma. Risk factors and mechanisms associated to PA are poorly understood. Although involvement of the nervous system in SARS-CoV-2 infection causing intracranial hemorrhagic complications has been documented, the association between COVID-19 infection and PA has yet to be determined. Methods . From a prospectively collected database of patients with pituitary adenomas, we retrospectively reviewed the electronical medical records and scans of patients with pituitary apoplexy during the COVID-19 outbreak, since March 2020 to December 2020, that were treated at a tertiary care center. Results. Herein, we report three consecutive cases of patients with PA and concomitant COVID-19 infection. Most common symptom at presentation was headache and visual worsening. Included patients were successfully treated with surgical decompression and medical management of the hormonal deficits, experiencing moderate to significant improvement of their visual symptoms at last follow up. COVID-19 infection in the perioperative period was corroborated throughout polymerase chain reaction testing in all patients. Conclusions. COVID-19 positive patients may be at an increased risk of developing PA. Angiotensin-converting enzyme 2 receptors expressed in cerebrovascular endothelium may potentially play a role in the molecular mechanisms that induce changes of the vascular autoregulation and cerebral blood flow and predispose to pituitary hemorrhage in patients harboring a pituitary adenoma.

Pituitary Apoplexy

2019 ◽  
pp. 225-228
Author(s):  
Sherri A. Braksick
Keyword(s):  
Ischemic Stroke ◽  
Pituitary Gland ◽  
Adrenal Insufficiency ◽  
Intracranial Hemorrhage ◽  
Pituitary Apoplexy ◽  
Life Threatening ◽  
Neurologic Emergency

Pituitary apoplexy is infarction of the pituitary gland by hemorrhage or ischemia. Although pituitary apoplexy is rare, it is a neurologic emergency and sometimes a neurosurgical and endocrine emergency that require rapid intervention to prevent severe and potentially life-threatening adrenal insufficiency, hydrocephalus, intracranial hemorrhage, or ischemic stroke.

scholarly journals Spontaneous remission of acromegaly: apoplexy mimicking meningitis or meningitis as a cause of apoplexy?

2014 ◽  
Vol 58 (1) ◽  
pp. 76-80 ◽  
Author(s):  
Rocío Villar-Taibo ◽  
María D. Ballesteros-Pomar ◽  
Alfonso Vidal-Casariego ◽  
Rosa M. Álvarez-San Martín ◽  
Georgios Kyriakos ◽  
...  
Keyword(s):  
Bacterial Meningitis ◽  
Pituitary Tumor ◽  
Pituitary Apoplexy ◽  
Signs And Symptoms ◽  
Spontaneous Remission ◽  
Clinical Syndrome ◽  
Complete Disappearance ◽  
Life Threatening ◽  
Neurological Processes ◽  
Magnetic Resonance Imaging Mri

Pituitary apoplexy is a rare but potentially life-threatening clinical syndrome characterized by ischemic infarction or hemorrhage into a pituitary tumor. The diagnosis of pituitary tumor apoplexy is frequently complicated because of the nonspecific nature of its signs and symptoms, which can mimic different neurological processes, including meningitis. Several factors have been associated with apoplexy, such as dopamine agonists, radiotherapy, or head trauma, but meningitis is a rarely reported cause. We describe the case of a 51-year-old woman with acromegaly due to a pituitary macroadenoma. Before surgical treatment, she arrived at Emergency with fever, nausea, vomiting and meningismus. Symptoms and laboratory tests suggested bacterial meningitis, and antibiotic therapy was initiated, with quick improvement. A computerized tomography (CT) scan at admission did not reveal any change in pituitary adenoma, but a few weeks later, magnetic resonance imaging (MRI) showed data of pituitary apoplexy with complete disappearance of the adenoma. Currently, her acromegaly is cured, but she developed hypopituitarism and diabetes insipidus following apoplexy. We question whether she really experienced meningitis leading to apoplexy or whether apoplexy was misinterpreted as meningitis. In conclusion, the relationship between meningitis and pituitary apoplexy may be bidirectional. Apoplexy can mimic viral or bacterial meningitis, but meningitis might cause apoplexy, as well. This fact highlights the importance of differential diagnosis when evaluating patients with pituitary adenomas and acute neurological symptoms.

scholarly journals Psychedelic medicines for existential distress associated with life-threatening illnesses

2022 ◽  
Vol 9 (1) ◽  
pp. 33
Author(s):  
Houman Farzin
Keyword(s):  
Palliative Care ◽  
Altered State ◽  
Psychoactive Substances ◽  
Current State ◽  
Existential Distress ◽  
Life Threatening ◽  
History Of ◽  
Altered State Of Consciousness ◽  
State Of Affairs ◽  
The Right

This presentation will review the history of scientific research into the use of psychedelic medicines for the treatment of existential distress due to life-threatening illnesses, it will then outline the current state of affairs in North America, and conclude with exploring the implications it will have on the future of palliative care. Despite the significant advances in the field of palliative care with regards to symptom management, and pain control in particular, we have yet to devise an effective treatment strategy for individuals facing the existential distress associated with the inevitable reality of facing death. Psychedelic-assisted therapy, which involves the use of various psychoactive substances in the right set and setting to experience an altered state of consciousness, could serve as a powerful tool to alleviate the anxiety that many face after receiving a life-threatening diagnosis.  

May-Thurner syndrome – Are we aware enough?

VASA ◽  
2019 ◽  
Vol 48 (5) ◽  
pp. 381-388 ◽  
Author(s):  
Katalin Mako ◽  
Attila Puskas
Keyword(s):  
Contraceptive Use ◽  
Iliac Vein ◽  
Common Iliac Vein ◽  
Vein Thrombosis ◽  
Compression Syndrome ◽  
Threatening Condition ◽  
Life Threatening ◽  
Iliac Vein Compression ◽  
Iliac Vein Compression Syndrome ◽  
The Right

Summary. Iliac vein compression syndrome (May-Thurner syndrome – MTS) is an anatomically variable clinical condition in which the left common iliac vein is compressed between the right common iliac artery and the underlying spine. This anatomic variant results in an increased incidence of left iliac or iliofemoral vein thrombosis. It predominantly affects young women in the second or third decades of life with preponderance during pregnancy or oral contraceptive use. Although MTS is rare, its true prevalence is underestimated but it can be a life-threatening condition due to development of pulmonary embolism (PE). In this case based review the authors present three cases of MTS. All patients had been previously confirmed with PE, but despite they were admitted to hospital, diagnosed and correctly treated for PE and investigated for thrombophilia, the iliac vein compression syndrome was not suspected or investigated. With this presentation the authors would like to emphasize that MTS is mostly underdiagnosed, and it needs to be ruled out in left iliofemoral vein thrombosis in young individuals.

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