A 64-year-old woman with dilated right pupil, nausea, and headache

Haider, Ali S; Rao, Prashanth J.

doi:10.5693/djo.03.2012.11.001

Cited by 2 publications

(6 citation statements)

References 17 publications

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“…In accordance with medical literature, we found a male predominance (male-to-female ratio of 1.76). The mean age of patients was 50.52 years, the youngest was 9, and the oldest was 85 years [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , ...…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

“…Other common symptoms include nausea and vomiting, either with a neurological or endocrine component (acute secondary adrenal insufficiency) [ 25 , 29 , 30 , 33 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , …”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

“…Complete blindness was reported in two papers [ 199 , 212 ]. Visual field defects varied from (mostly common) hemianopia [ 33 , 39 , 55 , 80 , 126 , 135 , 179 , 187 , 197 ] to cranial nerve palsies manifesting as diplopia in the majority of these cases [ 32 , 34 , 35 , 49 , 50 , 58 , 63 , 66 , 68 , 75 , 84 , 85 , 91 , 92 , 114 , 115 , 117 , 127 , 130 , 142 , 147 , 150 , 157 , 163 , 164 , 186 , 191 , 194 , 195 , 207 , 214 ] followed by ptosis [ 34 , 35 , 50 , 59 , 75 , 77 , 79 ,…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

“…Conservative management [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , …”

Section: Pitnet Complicated With Paunclassified

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Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

et al. 2023

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Various complications of pituitary neuroendocrine tumors (PitNET) are reported, and an intratumor hemorrhage or infarct underlying pituitary apoplexy (PA) represents an uncommon, yet potentially life-threatening, feature, and thus early recognition and prompt intervention are important. Our purpose is to overview PA from clinical presentation to management and outcome. This is a narrative review of the English-language, PubMed-based original articles from 2012 to 2022 concerning PA, with the exception of pregnancy- and COVID-19-associated PA, and non-spontaneous PA (prior specific therapy for PitNET). We identified 194 original papers including 1452 patients with PA (926 males, 525 females, and one transgender male; a male-to-female ratio of 1.76; mean age at PA diagnostic of 50.52 years, the youngest being 9, the oldest being 85). Clinical presentation included severe headache in the majority of cases (but some exceptions are registered, as well); neuro-ophthalmic panel with nausea and vomiting, meningism, and cerebral ischemia; respectively, decreased visual acuity to complete blindness in two cases; visual field defects: hemianopia, cranial nerve palsies manifesting as diplopia in the majority, followed by ptosis and ophthalmoplegia (most frequent cranial nerve affected was the oculomotor nerve, and, rarely, abducens and trochlear); proptosis (N = 2 cases). Risk factors are high blood pressure followed by diabetes mellitus as the main elements. Qualitative analysis also pointed out infections, trauma, hematologic conditions (thrombocytopenia, polycythemia), Takotsubo cardiomyopathy, and T3 thyrotoxicosis. Iatrogenic elements may be classified into three main categories: medication, diagnostic tests and techniques, and surgical procedures. The first group is dominated by anticoagulant and antiplatelet drugs; additionally, at a low level of statistical evidence, we mention androgen deprivation therapy for prostate cancer, chemotherapy, thyroxine therapy, oral contraceptives, and phosphodiesterase 5 inhibitors. The second category includes a dexamethasone suppression test, clomiphene use, combined endocrine stimulation tests, and a regadenoson myocardial perfusion scan. The third category involves major surgery, laparoscopic surgery, coronary artery bypass surgery, mitral valvuloplasty, endonasal surgery, and lumbar fusion surgery in a prone position. PA in PitNETs still represents a challenging condition requiring a multidisciplinary team from first presentation to short- and long-term management. Controversies involve the specific panel of risk factors and adequate protocols with concern to neurosurgical decisions and their timing versus conservative approach. The present decade-based analysis, to our knowledge the largest so far on published cases, confirms a lack of unanimous approach and criteria of intervention, a large panel of circumstantial events, and potential triggers with different levels of statistical significance, in addition to a heterogeneous clinical picture (if any, as seen in subacute PA) and a spectrum of evolution that varies from spontaneous remission and control of PitNET-associated hormonal excess to exitus. Awareness is mandatory. A total of 25 cohorts have been published so far with more than 10 PA cases/studies, whereas the largest cohorts enrolled around 100 patients. Further studies are necessary.

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Section: Pitnet Complicated With Pamentioning

confidence: 99%

Section: Pitnet Complicated With Pamentioning

confidence: 99%

Section: Pitnet Complicated With Pamentioning

confidence: 99%

Section: Pitnet Complicated With Paunclassified

See 2 more Smart Citations

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

et al. 2023

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“…Clinically stable patients, including those with isolated ocular motor palsies, can be managed conservatively with favorable outcomes. 6,7 For patients with progression of symptoms, surgery is indicated. Urgent surgical decompression is performed for altered consciousness or severe/progressive impairment of vision including reduced acuity or field loss.…”

Section: Sectionmentioning

confidence: 99%

Clinical Reasoning: A 41-year-old man with thunderclap headache

et al. 2018

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A 41-year-old man with a history of low testosterone on androgen therapy presented to the emergency department complaining of acute onset of the worst headache of his life. He reported being well until 6 hours earlier, when he was resting in his hotel room and experienced a thunderclap headache. The headache was initially described as retro-orbital, left-sided, associated with vomiting, and extending to the occiput. It was maximal within moments of onset. There were no associated visual complaints, weakness, numbness, or tingling. On initial examination, he was noted to have preserved mental status. The cranial nerve examination showed intact visual fields, normal extraocular motility, and no evidence of papilledema. Sensorimotor function was intact and symmetric throughout, and his gait was stable and narrow-based. Initial laboratory studies including blood count and metabolic panel were unremarkable. He was administered oxygen via nasal cannula, metoclopramide, and diphenhydramine without improvement. Questions for consideration: 1. What is the differential diagnosis for thunderclap headache? 2. What further evaluation should be pursued emergently? GO TO SECTION 2

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A 64-year-old woman with dilated right pupil, nausea, and headache

Abstract: HistoryAcute-onset paralysis of the oculomotor nerve has been described as the chief presenting complaint of pituitary apoplexy in only a few cases in the literature.

Cited by 2 publications

References 17 publications

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

Clinical Reasoning: A 41-year-old man with thunderclap headache

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