Neuro-Endocrine Recovery After Pituitary Apoplexy: Prolactin as a Predictive Factor

Lammert, Alexander; Walter, Marc Sebastian; Giordano, Frank A.; Zhgloul, Mansour Al; Krämer, Bernhard K.; Nittka, Stefanie; Schulte, Dirk Michael; Ratliff, Miriam; Hänggi, Daniel; Seiz-Rosenhagen, Marcel

doi:10.1055/a-0640-2915

Cited by 12 publications

(3 citation statements)

References 29 publications

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“…[ 14 ] Also, PRL level is a predictor for postoperative neuroendocrine recovery in patients with pituitary apoplexy. [ 15 ] The natural course of PRL dynamic after surgery could facilitate further understanding of the mechanism of postoperative hyperprolactinemia.…”

Section: Introductionmentioning

confidence: 99%

Hyperprolactinemia in clinical non-functional pituitary macroadenomas

Lyu

Yin²,

Hu³

et al. 2020

Medicine

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Hyperprolactinemia is a prevalent endocrine disorder presented in patients with non-functional pituitary adenomas (NFPAs). However, the mechanism involved in hyperprolactinemia in NFPA is not fully illustrated. The current study aims to investigate predictors for hyperprolactinemia in NFPA via analyzing relevant clinical features. Thus, in this study, a cohort of 214 cases with integrated medical records was retrospectively analyzed concerning clinical, pathological, and endocrinological studies before and after surgery. Hyperprolactinemia happened in 93 cases (43.5%). Women (adjust odds ratio [OR] = 3.093; P < .01), age of patients (adjust OR = 0.951; P < .01), and serum free tetraiodothyronine (FT4) level (adjust OR = 0.882; P = .02) were independent predictors for developing preoperative hyperprolactinemia. Tumor size and hypopituitarism had no impact on hyperprolactinemia. During a median follow-up of 43.5 (range, 22–80) months, 83.9% patients with preoperative hyperprolactinemia experienced prolactin (PRL) normalization. Preoperative PRL level (adjusted OR = 1.741, P = .03) was the exclusive predictor for PRL normalization after adjusting for tumor volume, preoperative serum FT4 concentration, and postoperative residual. The PRL normalization rate of patients with lower PRL level (<2.35-fold upper limit of normal range) was 95.2% and decreased to 65.5% for patients with higher PRL level. In conclusion, our results suggest existence of potentially alternative mechanisms underlying hyperprolactinemia in NFPAs, like the discrepancy of sex and age and the negative feedback of FT4. Preoperative PRL is a predictor for postoperative PRL normalization, which is of clinically relevant for postoperative management of NFPAs.

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Section: Introductionmentioning

confidence: 99%

Hyperprolactinemia in clinical non-functional pituitary macroadenomas

Lyu

Yin²,

Hu³

et al. 2020

Medicine

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“…Se postula que el mecanismo de esta alteración es el resultado de la compresión aguda que resulta en disminución de la irrigación del tejido hipofisario normal, a lo cual podría sumarse la dificultad en distinguir el tejido hipofisario normal del patológico en contexto de necrosis y hemorragia durante la cirugía. Se ha sugerido que los niveles bajos de prolactina podrían indicar una baja posibilidad de recuperación endocrinológica 8,19,22 .…”

Section: Discussionunclassified

Apoplejía hipofisaria: análisis de una serie de 14 casos operados por vía endoscópica endonasal.

Melgarejo

2022

Rev. Argent. Neuroc.

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Objetivo. Presentar una serie de casos de apoplejía hipofisaria (AH) intervenidos quirúrgicamente por vía endoscópica endonasal y analizar los resultados. Material y métodos. Se examinaron en forma retrospectiva las historias clínicas de 14 pacientes con AH intervenidos quirúrgicamente en ambos Servicios de Neurocirugía de la Ciudad de Buenos Aires, en el periodo comprendido entre enero de 2013 y diciembre de 2019. Se analizaron los resultados de las evaluaciones endocrinológicas, oftalmológicas, anatomopatológicas y quirúrgicas, como así también las complicaciones. Resultados. Se incluyeron 14 pacientes, 11 varones (78,5%), con una media de edad de 55,5 años. Doce (85,7%) pacientes se presentaron con alteraciones en el campo visual y 5 (35,1%) con oftalmoplejía. Once (78,5%) fueron macroadenomas y 3 (21,4%) adenomas gigantes; según el grado de Knosp se presentaron 4 (28,5%) adenomas invasores y 10 (71,4%) no invasores. Todos fueron intervenidos quirúrgicamente dentro de las 48 horas del ingreso hospitalario y todos presentaron mejoría visual en el postoperatorio. De los 8 pacientes (57,1%) con hipopituitarismo previo a la cirugía, ninguno recuperó función hipofisaria. Las resecciones fueron totales, subtotales y parciales en 8 (57,1%), 3 (21,4%) y 3 (21,4%) pacientes respectivamente. Las complicaciones fueron una epistaxis, 1 síndrome de secreción inapropiada de hormona antidiurética y un óbito en el postoperatorio tardío. Conclusiones. La cirugía endoscópica endonasal es una alternativa efectiva y segura para el tratamiento de la AH. En nuestra serie obtuvimos mejoría del déficit visual y la oftalmoparesia en todos los casos; por el contrario los déficits adenohipofisarios persistieron, requiriendo tratamiento hormonal sustitutivo. El trabajo multidisciplinario es de vital importancia para el manejo de esta patología.

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“…Regardless of the surgical timing, overall, a substantial proportion of patients have improvement in visual deficits (57%-95%) and cranial nerve palsies (63%-100%); however, the proportion who have pituitary function improvement is lower (19%-57%) [ 33 ]. A small retrospective study of 24 patients with PA suggested that preoperatively prolactin levels greater than 8.8 ng/mL may be predictive of pituitary endocrine function recovery [ 65 ], but this has not been replicated. Another study proposed that normal or high prolactin levels may indicate viable pituitary tissue with a higher chance of hypopituitarism recovery following surgery [ 26 ].…”

Section: Managementmentioning

confidence: 99%

Revisiting Pituitary Apoplexy

Donegan

Erickson

2022

Journal of the Endocrine Society

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Pituitary apoplexy (PA) is a rare clinical syndrome due to pituitary hemorrhage or infarction. It is characterized by the sudden onset of one or more of the following: severe headache, visual disturbance, nausea/vomiting and or altered mental status. Most commonly, PA occurs in an underlying pituitary adenoma. The pathophysiology is not fully understood, but it is thought to involve elements of increased metabolic demand and or compromise to the vasculature of the pituitary or pituitary tumor. Several risk factors have been described. Stabilization of patient on presentation, replacement of hormonal deficiencies and reversal of electrolyte abnormalities are the recommended initial steps in the management of patients with PA. Surgical decompression of the mass effect had been the recommended treatment for patients with PA, however retrospective studies of patients with PA have demonstrated similar outcomes when a conservative approach is applied. This suggests that in highly selected clinical scenarios (mild visual deficit and improving symptoms), conservative management is possible. Further studies however are necessary to better stratify patients but are limited by the rarity of the condition and the acuity.

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Neuro-Endocrine Recovery After Pituitary Apoplexy: Prolactin as a Predictive Factor

Cited by 12 publications

References 29 publications

Hyperprolactinemia in clinical non-functional pituitary macroadenomas

Hyperprolactinemia in clinical non-functional pituitary macroadenomas

Apoplejía hipofisaria: análisis de una serie de 14 casos operados por vía endoscópica endonasal.

Revisiting Pituitary Apoplexy

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