Acute Degenerative Changes in Adenomas of the Pituitary Body—with Special Reference to Pituitary Apoplexy

Brougham, Mark; Ap, Heusner; Rd, Adams

doi:10.3171/jns.1950.7.5.0421

Cited by 264 publications

(134 citation statements)

References 6 publications

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“…The term "pituitary apoplexy" was coined years later by Brougham et al 3 It is a potentially life-threatening disorder occurring due to acute ischemic infarction or hemorrhage within the pituitary gland, usually within a pituitary tumor. Most cases of pituitary apoplexy present in the fifth or sixth decade with a slight male preponderance ranging from 1.1 to 2.25:1.0.…”

Section: Discussionmentioning

confidence: 99%

Pituitary Apoplexy presenting as Bilateral Ophthalmoplegia

Dhiware¹,

Deshpande²,

Patkar³

et al. 2017

MGM Journal of Medical Sciences

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Pituitary apoplexy is an endocrinological emergency, usually occurring in a pituitary adenoma and is caused by sudden onset hemorrhage and ischemic necrosis of the pituitary gland. Sudden-onset headache along with vomiting is the usual presenting feature. Signs of meningism, however, occur late and are not a characteristic feature. These may be associated with other neurological features like disturbances of consciousness, vertigo, and hemiparesis. Ocular features include marked reduction in the visual acuity with bitemporal hemianopia, diplopia, and ophthalmoplegia due to ocular motor nerve palsies. Acute pituitary apoplexy is unpredictable and should be considered in any patient with abrupt neuro-ophthalmological deterioration associated with headache. We report a unique case of pituitary apoplexy with bilateral total ophthalmoplegia having complete oculomotor nerve palsy in one eye and pupil-sparing oculomotor nerve palsy in the other.

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Section: Discussionmentioning

confidence: 99%

Pituitary Apoplexy presenting as Bilateral Ophthalmoplegia

Dhiware¹,

Deshpande²,

Patkar³

et al. 2017

MGM Journal of Medical Sciences

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“…28 It also occurs silently without production of symptoms, as shown by histological features consistent with apoplexy in as many as 25% of microadenomas removed surgically. 24,37 Previously proposed mechanisms for pituitary apoplexy include reduced blood supply to the tumor produced by events such as hypotension, rapid growth outpacing the development of adequate blood supply to the tumor, 12 direct pressure by the tumor on the portal vessels or the hypophyseal arteries causing acute ischemia of the tumor, 32 increased intratumoral pressure which itself acutely impairs the blood flow to the tumor, 47 increased metabolic activity beyond adequate arterial supply after stimulation with hypothalamic releasing factors, 31 and hemorrhage resulting from fragility of the tumor vessels. 10 There is evidence supporting these proposed mechanisms as contributing factors in acute pituitary apoplexy.…”

Section: Discussionmentioning

confidence: 99%

Apoplexy of pituitary adenomas: the perfect storm

Oldfield

Merrill

2015

JNS

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Pituitary tumors spontaneously infarct at a relatively high rate, higher than any other CNS tumor. This occurs with or without hemorrhage. The typical clinical entity was described relatively late, in 1950, by Brougham et al. 12 Since then pituitary apoplexy has been the subject of many reports describing the clinical presentation, patient management, imaging features, and outcome, as well as reports of acute circumstances predisposing to its occurrence. 9,10,14,15,17,[22][23][24][25]29,32,36,37,39,45 We propose here that infarction of these tumors is the product of a combination of intrinsic features of these tumors and that it is the tenuous imbalance between their high rate of demand for nutrients combined with their limited intrinsic blood supply that makes them vulnerable to infarction, with or without precipitating events, and suggest that this circumstance may permit new approaches to treatment based on this peculiar vulnerability. case of Pituitary apoplexyA 57-year-old male had the sudden onset of headache followed by excessive thirst, polydipsia, loss of energy, and abbreviatioNs FDG = fluorodeoxyglucose; PET = positron emission tomography; VEGF = vascular endothelial growth factor. submitted July 25, 2014. accePted October 8, 2014. iNclude wheN citiNg Published online April 10, 2015; DOI: 10.3171/2014.10.JNS141720. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect Pituitary adenomas occasionally undergo infarction, apoplexy, which often destroys much of the tumor. It is well known that apoplexy can be precipitated by several acute factors, including cardiac surgery, other types of surgery, trauma, insulin infusion, and stimulation with administration of hypothalamic releasing factors. methods The prior focus on mechanisms underlying pituitary apoplexy has been on these acute events. Less attention has been given to the endogenous features of pituitary tumors that make them susceptible to spontaneous infarction, despite that most pituitary apoplexy occurs in the absence of a recognized precipitating event. The authors examine intrinsic features of pituitary adenomas that render them vulnerable to apoplexy-features such as high metabolic demand, paucity of angiogenesis, and sparse vascularity, qualities that have previously not been linked with apoplexy-and argue that it is these features of adenomas that underlie their susceptibility to spontaneous infarction. The sensitivity of freshly cultured pituitary adenomas to hypoglycemia is assessed. results Adenomas have high metabolic demand, limited angiogenesis, and reduced vessel density compared with the normal gland. Pituitary adenoma cells do not survive in the presence of reduced or absent concentrations of glucose. coNclusioNs The authors propose that the frequent ischemic infarction of pituitary adenomas is the product of intrinsic features of these tumors. These endogenous qualities create a tenuous balance between high metabolic demand and ...

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“…3,9,24,26,29,30 Pituitary apoplexy is usually heralded by an abrupt onset of severe headache, nausea, vomiting, deterioration of vision, restriction of visual fields, ophthalmoplegia, or, infrequently, altered sensorium. The unique clinical manifestation was first described by Bleibtreu in 1905, 5 while the term currently ascribed to the condition (pituitary apoplexy) was first coined in 1950 by Brougham et al, 8 who described 5 patients who died suddenly, in whom postmortem autopsy revealed hemorrhage and necrosis of a pituitary adenoma. The incidence of pituitary apoplexy ranges from 0.6% to 22%.…”

Section: Pituitary Apoplexymentioning

confidence: 99%

Combined chronic lymphocytic leukemia and prolactinoma: a rare occurrence in a patient presenting with pituitary apoplexy

Krisht

Palmer

Couldwell

2013

JNS

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Pituitary involvement in B-cell CLL and pituitary apoplexy, independently, are 2 rare events. Their co-occurrence in addition to the presence of prolactin-secreting adenoma cells, however, has never been described in the literature. We present the case of a combined pituitary CLL and prolactinoma apoplexy in a 77-year-old man to highlight the importance of imaging the brain in patients with CLL who present with signs and symptoms of pituitary apoplexy. To the best of our knowledge, there are only 2 other reported cases of CLL manifesting as a pituitary mass lesion.11,21 The current case is the first instance of a combined pituitary CLL-prolactinoma presenting with pituitary apoplexy. This case illustrates the need to carefully evaluate pituitary tumor specimens from patients with CLL for small lymphocytic infiltration, notwithstanding the presence of pituitary adenoma cells. Case ReportHistory and Examination. This 77-year-old man with untreated CLL diagnosed 8 years earlier presented with a 2-day history of severe bifrontal headaches associated with nausea and vomiting, including left facial numbness and complete ophthalmoplegia of his left eye. Three weeks prior to his admission he was hospitalized at an outside hospital for a pulmonary embolus and discharged on a regimen of 5 mg of oral warfarin at bedtime along with subcutaneous injections of 115 mg of enoxaparin every 12 hours as a bridging therapy. At his initial examination at our institution, he was awake, alert, and fully oriented. Positive findings included complete dense ophthalmoplegia of the left eye, diminished facial sensation to all sensory modalities along the V1 and V2 distributions, and right eye blindness secondary to glaucoma. Visual acuity remained Combined chronic lymphocytic leukemia and prolactinoma: a rare occurrence in a patient presenting with pituitary apoplexy The authors describe a rare case of combined pituitary chronic lymphocytic leukemia (CLL) and prolactinoma in a 77-year-old man presenting with apoplexy. This case highlights the importance of evaluating the pituitary gland in patients with CLL who present with clinical manifestations of apoplexy as well as the need to carefully evaluate pathological specimens from the gland for the presence of lymphocytic cells in those patients. This is the first reported case of a combined CLL-prolactinoma pituitary lesion presenting with apoplexy.

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Acute Degenerative Changes in Adenomas of the Pituitary Body—with Special Reference to Pituitary Apoplexy

Cited by 264 publications

References 6 publications

Pituitary Apoplexy presenting as Bilateral Ophthalmoplegia

Pituitary Apoplexy presenting as Bilateral Ophthalmoplegia

Apoplexy of pituitary adenomas: the perfect storm

Combined chronic lymphocytic leukemia and prolactinoma: a rare occurrence in a patient presenting with pituitary apoplexy

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