Empty Sella in the Making

Biloš, Lora Stanka Kirigin; Kruljac, Ivan; Radošević, Jelena Marinković; Čačić, Marko; Škoro, Ivan; Čerina, Vatroslav; Pećina, Ivan Hrvoje; Vrkljan, Milan

doi:10.1016/j.wneu.2019.05.119

Cited by 2 publications

(3 citation statements)

References 18 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Kirigin Biloš et al . postulate that conservative management of PA may be a proper alternative to surgery, although it is challenging to assess which patients can be safely monitored versus those at risk of negative outcomes because the risk factors for tumor progression or recurrent apoplexy remain unknown ( 24 ).…”

Section: Discussionmentioning

confidence: 99%

“…One of the first to suggest conservative approach were Pelkonen et al in 1978, whereas Maccagnan et al report that conservative management was possible in 60% of patients with a similar post-treatment prevalence of pituitary hormone deficiency and incidence of tumor recurrence in patients who underwent surgical or conservative treatment 22,23 . Kirigin Biloš et al postulate that conservative management of PA may be a proper alternative to surgery, although it is challenging to assess which patients can be safely monitored versus those at risk of negative outcomes because the risk factors for tumor progression or recurrent apoplexy remain unknown 24 .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Spontaneous Resolution of a Nonfunctioning Pituitary Adenoma over One-Month Period: a Case Report

Komić

Kruljac

Mirošević

et al. 2021

ACC

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Spontaneous Resolution of a Nonfunctioning Pituitary Adenoma over One-Month Period: a Case Report

Komić

Kruljac

Mirošević

et al. 2021

ACC

View full text Add to dashboard Cite

“…One case of gigantism (+5 SD) was reported on a 9-year-old boy with lactosomatotroph PitNET [ 32 ]. Hypopituitarism included elements of hypogonadism [ 127 , 128 , 129 , 131 , 135 ] like disturbances of menstrual cycle in women of reproductive age [ 171 , 172 ], etc., but, also, with a more severe potential, hypotension [ 29 , 48 , 83 , 199 , 210 , 213 ].…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

et al. 2023

View full text Add to dashboard Cite

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.

show abstract

Empty Sella in the Making

Cited by 2 publications

References 18 publications

Spontaneous Resolution of a Nonfunctioning Pituitary Adenoma over One-Month Period: a Case Report

Spontaneous Resolution of a Nonfunctioning Pituitary Adenoma over One-Month Period: a Case Report

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

Contact Info

Product

Resources

About