scholarly journals Sudden onset isolated complete third nerve palsy due to pituitary apoplexy

2011 ◽  
Vol 4 (1) ◽  
pp. 32 ◽  
Author(s):  
Batuk Diyora ◽  
Naren Nayak ◽  
Sanjay Kukreja ◽  
Hanmant Kamble
Keyword(s):  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Sudden Onset ◽  
Third Nerve Palsy ◽  
Third Nerve

scholarly journals Symptoms of pituitary apoplexy rapidly reversed with bromocriptine

1996 ◽  
Vol 1 (1) ◽  
pp. E8 ◽  
Author(s):  
Michael H. Brisman ◽  
Gillian Katz ◽  
Kalmon D. Post
Keyword(s):  
Steroid Therapy ◽  
Emergency Surgery ◽  
Visual Function ◽  
Prolactin Level ◽  
Pituitary Tumor ◽  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Rapid Progression ◽  
Third Nerve Palsy ◽  
Third Nerve

Macroprolactinomas rarely present with apoplexy. The authors describe a patient with a macroprolactinoma who presented with apoplexy and rapid progression of a third nerve palsy. The patient was managed expectantly with bromocriptine therapy, and within 48 hours, the patient's third nerve palsy had completely resolved. The authors suggest that all patients who present with pituitary apoplexy in the presence of a pituitary tumor receive an immediate course of bromocriptine and steroid therapy until the prolactin level can be determined. Emergency surgery is indicated if visual function is abnormal and the tumor is not a prolactinoma.

Symptoms of pituitary apoplexy rapidly reversed with bromocriptine

1996 ◽  
Vol 85 (6) ◽  
pp. 1153-1155 ◽  
Author(s):  
Michael H. Brisman ◽  
Gillian Katz ◽  
Kalmon D. Post
Keyword(s):  
Emergency Surgery ◽  
Visual Function ◽  
Prolactin Level ◽  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Rapid Progression ◽  
Content Type ◽  
Third Nerve Palsy ◽  
Third Nerve ◽  
Fine Print

✓ Macroprolactinomas rarely present with apoplexy. The authors describe a patient with a macroprolactinoma who presented with apoplexy and rapid progression of a third nerve palsy. The patient was managed expectantly with bromocriptine, and within 48 hours, the patient's third nerve palsy had completely resolved. The authors suggest that all patients who present with pituitary apoplexy in the presence of a pituitary tumor receive an immediate course of bromocriptine and steroid therapy until the prolactin level can be determined. Emergency surgery is indicated if visual function is abnormal and the tumor is not a prolactinoma.

PO17-TU-09 Pituitary apoplexy presenting with bilateral third nerve palsy and bilateral proptosis: case report

2009 ◽  
Vol 285 ◽  
pp. S241-S242
Author(s):  
G. Ayberk ◽  
H.F. Komurcu ◽  
M.F. Ozveren ◽  
N. Ozturk ◽  
O. Anlar
Keyword(s):  
Case Report ◽  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Third Nerve Palsy ◽  
Third Nerve

scholarly journals Gonadotropin-releasing hormone agonist-induced pituitary apoplexy

2016 ◽  
Vol 2016 ◽  
Author(s):  
Fergus Keane ◽  
Aoife M Egan ◽  
Patrick Navin ◽  
Francesca Brett ◽  
Michael C Dennedy
Keyword(s):  
Gnrh Agonist ◽  
Nerve Palsy ◽  
Gnrh Antagonist ◽  
Pituitary Apoplexy ◽  
Data Interpretation ◽  
Gonadotropin Releasing Hormone ◽  
Pituitary Macroadenoma ◽  
Agonist Therapy ◽  
Third Nerve Palsy ◽  
Third Nerve

Summary Pituitary apoplexy represents an uncommon endocrine emergency with potentially life-threatening consequences. Drug-induced pituitary apoplexy is a rare but important consideration when evaluating patients with this presentation. We describe an unusual case of a patient with a known pituitary macroadenoma presenting with acute-onset third nerve palsy and headache secondary to tumour enlargement and apoplexy. This followed gonadotropin-releasing hormone (GNRH) agonist therapy used to treat metastatic prostate carcinoma. Following acute management, the patient underwent transphenoidal debulking of his pituitary gland with resolution of his third nerve palsy. Subsequent retrospective data interpretation revealed that this had been a secretory gonadotropinoma and GNRH agonist therapy resulted in raised gonadotropins and testosterone. Hence, further management of his prostate carcinoma required GNRH antagonist therapy and external beam radiotherapy. This case demonstrates an uncommon complication of GNRH agonist therapy in the setting of a pituitary macroadenoma. It also highlights the importance of careful, serial data interpretation in patients with pituitary adenomas. Finally, this case presents a unique insight into the challenges of managing a hormonal-dependent prostate cancer in a patient with a secretory pituitary tumour. Learning points While non-functioning gonadotropinomas represent the most common form of pituitary macroadenoma, functioning gonadotropinomas are exceedingly rare. Acute tumour enlargement, with potential pituitary apoplexy, is a rare but important adverse effect arising from GNRH agonist therapy in the presence of both functioning and non-functioning pituitary gonadotropinomas. GNRH antagonist therapy represents an alternative treatment option for patients with hormonal therapy-requiring prostate cancer, who also have diagnosed with a pituitary gonadotropinoma.

scholarly journals A Rare Event: Pituitary Apoplexy 6 Weeks After Gamma Knife Radiosurgery for a Non-Functioning Pituitary Macroadenoma

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A568-A569
Author(s):  
Gabrielle Sach ◽  
Yu-Fang Wu ◽  
John Fuller ◽  
Andrew Davidson ◽  
Bernard Champion ◽  
...  
Keyword(s):  
Gamma Knife ◽  
Cranial Nerve ◽  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Hormone Replacement ◽  
Gamma Knife Radiosurgery ◽  
Pituitary Macroadenoma ◽  
Single Fraction ◽  
Third Nerve Palsy ◽  
Third Nerve

Abstract Background: Pituitary apoplexy is a very uncommon side effect of gamma-knife radiosurgery, with only one other case to our knowledge. We report an acute presentation of pituitary apoplexy within 6 weeks of single fraction gamma-knife stereotactic radiosurgery for a non-functioning pituitary macroadenoma. Clinical Case: An 84-year-old male presented initially to his GP with lethargy. He was found to have a non-functioning pituitary macroadenoma 23Tx17APx12CC mm, with right cavernous sinus invasion causing cranial nerve IV palsy and panhypopituitarism. He declined transsphenoidal surgery. He was managed with pituitary hormone replacement therapy, including full anterior hormone replacement. Approximately 6 months after his initial diagnosis, he underwent single fraction stereotactic gamma knife radiosurgery aimed at local control. One month after single fraction gamma knife radiosurgery the patient presented to another hospital with a new two-day history of nausea, vomiting and persistent bilateral retro-orbital headache. On examination, he was afebrile and alert, with a new third nerve palsy of the right eye. The initial diagnosis was presumed steroid-underdosing by the non-treating team. An MRI of the brain and pituitary gland was performed. Review by the patient’s usual multidisciplinary pituitary care team confirmed acute pituitary apoplexy, with new haemorrhage on imaging in the gland post-gamma knife radiosurgery, with the additional clinical relevant development of a right cranial nerve III palsy. Review of the biochemistry showed to the patient to have a cortisol of <28nmol/L (despite Cortate ingestion), TSH <0.005mIU/L (RI: 0.40-5.00), T4 10.6 pmol/L (RI: 10.0-20.0) and T3 4.1 pmol/L (RI: 2.3-5.7). The patient was commenced on dexamethasone to aid reduction of swelling in the pituitary fossa, and there was resolution of the third nerve palsy. Pituitary apoplexy usually occurs spontaneously without any known precipitant. It has been reported to occur in association with other conditions including fractionated radiotherapy, head trauma, estrogen, anticoagulants1. Gamma knife radiosurgery is a form of stereotactic radiosurgery for intracerebral lesions, with lower overall dose and usually complications. Conclusion: To our knowledge, this is the second case of gamma-knife associated pituitary apoplexy. It raises the importance of recognising an acute clinical deterioration in our patients. References: 1. Briet C, Salenave S, Bonneville JF, Laws ER, Chanson P. Pituitary apoplexy. Endocrine reviews. 2015 Dec 1;36(6):622-45.

Pituitary apoplexy: A cause for painful third nerve palsy

1990 ◽  
Vol 10 (5) ◽  
pp. 257-260 ◽  
Author(s):  
Rosemary Robinson ◽  
James Toland ◽  
Peter Eustace
Keyword(s):  
Nerve Palsy ◽  
Pituitary Apoplexy ◽  
Third Nerve Palsy ◽  
Third Nerve

Left suboccipital supracerebellar transtentorial approach for resection of tectal cavernous malformation

2019 ◽  
Vol 1 (2) ◽  
pp. V19
Author(s):  
Hussam Abou-Al-Shaar ◽  
Timothy G. White ◽  
Ivo Peto ◽  
Amir R. Dehdashti
Keyword(s):  
Nerve Palsy ◽  
Oculomotor Nerve ◽  
Oculomotor Nerve Palsy ◽  
Entry Zone ◽  
Third Nerve Palsy ◽  
History Of ◽  
Tectal Plate ◽  
The Right ◽  
Transtentorial Approach ◽  
Third Nerve

A 64-year-old man with a midbrain cavernoma and prior bleeding presented with a 1-week history of diplopia, partial left oculomotor nerve palsy, and worsening dysmetria and right-sided weakness. MRI revealed a hemorrhagic left tectal plate and midbrain cavernoma. A left suboccipital supracerebellar transtentorial approach in the sitting position was performed for resection of his lesion utilizing the lateral mesencephalic sulcus safe entry zone. Postoperatively, he developed a partial right oculomotor nerve palsy; imaging depicted complete resection of the cavernoma. He recovered from the right third nerve palsy, weakness, and dysmetria, with significant improvement of his partial left third nerve palsy.The video can be found here: https://youtu.be/ofj8zFWNUGU.

Sign in / Sign up

Export Citation Format

Share Document