Pituitary Apoplexy

Abstract

Pituitary apoplexy is a rare clinical emergency due to acute ischemic infarction or hemorrhage of the pituitary gland. As this disorder most often involves a pituitary adenoma, especially nonfunctioning tumors, the syndrome should be referred to as pituitary tumor apoplexy. The precise physiopathology is not completely clear. Although in most cases it occurs spontaneously, pituitary apoplexy can be precipitated by many risk factors. The main symptom is headache of sudden onset associated with visual disturbances, signs of meningeal irritation, and/or endocrine dysfunction. Corticotropic deficiency is a potentially life-threatening disorder. Magnetic resonance imaging is the most sensitive to confirm the diagnosis by revealing a pituitary tumor with hemorrhagic and/or necrotic components. Earlier studies used to consider urgent decompression of the lesion surgically, but nowadays, more recent studies favor conservative management in selected patients (those without important visual acuity or field defects and with normal consciousness). This wait-and-see approach gives evidence of excellent outcomes in terms of oculomotor palsy, pituitary function, and subsequent tumor growth. Surgical decompression may be necessary in some cases. Once the acute phase is over, the patient should be reevaluated for hormonal deficiencies. Moreover, spontaneous remission of syndromes, such as acromegaly, may be caused by pituitary adenoma apoplexy.

Studying the genotype of Aryl Hydrocarbon Receptor-Interacting Protein (AIP) Gene (rs641081C>A) in ‎Iraqi Samples with Acromegaly Pituitary Adenoma

“…Moreover, these conditions can develop at an early age but may not be linked to the genetic condition until decades later. The penetrance of pituitary disease in AIP mutations patients has been assessed in a few families 30,31 . In two families, 30 to 50% of asymptomatic mutation carriers have been diagnosed with high prolactin or IGF1levels with normal pituitary magnetic resonance imaging (MRI) findings.…”

“…In two families, 30 to 50% of asymptomatic mutation carriers have been diagnosed with high prolactin or IGF1levels with normal pituitary magnetic resonance imaging (MRI) findings. 30,31 These percentages are based on very preliminary investigations. Extra pituitary disorders related to mutation of AIP could be suspected because of the AIP expression of non-endocrine specificity.…”

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“…Diabetes Type 1 is rare in patients with Pituitary Apoplexy on the onset. Studies show that less than 5% of these patients display symptoms of Diabetes Type 1 [16][17][18]. However, PA may be masked by the secondary failure of the adrenaline, a condition referred to as hypothyroidism.…”