Clusterlike Headache in a Patient With a Pituitary Adenoma. With a Review of Literature

Abstract

A man had left-sided atypical clusterlike headache for II years before he developed symptoms and signs consistent with acromegaly. Preoperative evaluation revealed raised levels of somatomedin C and growth hormone. An MR indicated a left-sided intrasellar mass measuring 8 x 7.5 x 10 mm. He underwent surgery and microscopy confirmed the diagnosis of a benign hypophyseal adenoma. Postoperatively, the acromegalic features regressed, and for the last 4 years the patient has been completely free from headache attacks. On pharmacological testing of the pupillary response to 19 and 5% phenylephrine and 2% tyramine solutions, there was no convincing evidence of persistent sympathetic dysfunction on the earlier symptomatic side.Key words: acromegaly, clusterlike headache, phenylephrine pituitary adenoma, pupil, tyramine Abbreviations: GH growth hormone (Headache 1996;36:184-188) The pathophysiology of cluster headache remains unclear. In most instances, every extensive neurological and neuroradiological examinations will be normal. 1 However. symptomatic clusterlike headache has been reported in a variety of pathological conditions with varying locations. [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16] Recently, pathophysiological interest has been focused on basal midline structures and in particular, the cavernous sinus. [17][18][19][20][21][22][23] We report a case of clusterlike headache associated with an intrasellar pituitary adenoma causing acromegaly. The relevance of the tumor location and its possible implications for the symptomatology, particularly with respect to sympathetic dysfunction, are discussed. CASE HISTORYA 37-year-old man had suffered from left-sided headache attacks for 4 years before he sough medical advice at the Department of Neurology Malmö University Hospital in 1985. His previous history was unremarkable. The headache was strictly left-sided and located behind the eye; radiating towards the left ear, the occiput, and the neck. Because the pain also involved the teeth in the left upper jaw, he had undergone dental treatments, including correction of bite, all of which had been in vain.The attacks occurred with varying intervals of weeks or months. The pain was excruciating, with a stinging and pulsating character. It always started at about the same time in the afternoon and lasted for up to 7 or 8 hours. The patient could only get some relief by a high intake of phenacetin and acetylsalicylic acid. However, by pouring hot water over the neck or by massaging the occipital region on the left side, he could also obtain considerable relief. The pain never sub sided completely before he went to bed. Initially, when the headache attacks started, he thought that attacks could be provoked by intense sunlight, shimmering waves, but also by a cold wind blowing in the face. Whenever he suffered an attack, his left eye was reddened with markedly increased lacrimation. The left nostril was blocked and there was rhinorrhea. During an attack, he did not experience nausea, nor did he ever vomit. Som...

A case of a GH–producing pituitary adenoma associated with a unilateral headache with autonomic signs

“…Hannerz [12] hypothesised that the adenoma induced an impairment of venous flow in the carotid sinus and/or of the superior ophthalmic vein with subsequent vasculitis of the orbital sinus. These events caused stimulation of the first or second trigeminal branches and activation of the trigeminovascular system [12][13][14][15]. Other authors hypothesised, instead, that the adenoma pulled on the bony sellar septum and excited the meningeal arteries and trigeminal fibres located there [4,16].…”

Pregnancy promotes pituitary tumors by increasing the rate of the cell cycle

“…The average weight of the mice was 30 g. All the mice were randomly separated into 2 groups with 8 mice in each group and numbered with identifiers. Each mouse was subcutaneously injected with 5x10 6 AtT-20 cells. After 7 days, one group of mice was mated with male mice, whereas the other group were raised in the same conditions as the pregnant mice (SPF animal facility and fed with sterilized food and water).…”

“…Since the pituitary gland is close to the brain, invasive pituitary adenomas may invade the cranial bone and lead to side effects (4). They may induce increased intracranial pressure and various types of headache (5,6).…”

Migrainelike Headache in a Patient With a Hemorrhagic Pituitary Macroadenoma

“…Pituitary macroadenomas can present with trigeminal neuralgia, Raeder's syndrome, 4 and clusterlike headaches. 5 Pituitary macroadenomas with hemorrhage can result in a migrainelike headache with an oculomotor nerve palsy 6 or a migrainelike headache without aura with a normal examination. Although uncommon, pituitary hemorrhage with and without apoplexy should be considered in the differential diagnosis of acute headache.…”