Pituitary Apoplexy

Semple, Patrick; Webb, Michael K.; Villiers, J. C. De; Laws, Edward R.

doi:10.1227/01.neu.0000144840.55247.38

Cited by 231 publications

(239 citation statements)

References 32 publications

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“…This is not unique to our practice. A range of "a few hours to 80 days" of time-to-presentation was noted in another larger series of apoplexy patients [4]. The optimal time for surgical intervention is still under debate, although many advocate for early intervention [6,[8][9][10].…”

Section: Discussionmentioning

confidence: 97%

“…It is generally considered a diagnosis based on symptoms and imaging; however, intraoperative and pathological findings of hemorrhage have been used to identify "subclinical (asymptomatic) apoplexy" [1,3]. The severity of the symptoms can vary and the diagnosis is not always straightforward [1,[3][4]. The manifestations of pituitary apoplexy are attributed to the rapid expansion of an infarcted and/or hemorrhagic pituitary adenoma that has extended laterally into the cavernous sinus or superiorly to displace the optic chiasm and apparatus, with an occasional extension of the hemorrhage into the surrounding subarachnoid space [1][2].…”

mentioning

confidence: 99%

“…In the absence of significant or progressive visual symptoms, non-surgical management (i.e., hormone replacement) can be considered as the sole therapy. Although a few reports (with inherent patient selection biases) have shown equivalent post-treatment results between surgical and non-surgical management, particularly for the symptom of ophthalmoplegia, more patients are treated surgically in most reported series [4,11].…”

mentioning

confidence: 99%

See 2 more Smart Citations

Endoscopic Endonasal Transsphenoidal Treatment of Pituitary Apoplexy: Outcomes in a Series of 20 Patients

Yang¹,

Anand²,

Schwartz³

2013

J Neurol Surg B

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Section: Discussionmentioning

confidence: 97%

mentioning

confidence: 99%

mentioning

confidence: 99%

See 1 more Smart Citation

Endoscopic Endonasal Transsphenoidal Treatment of Pituitary Apoplexy: Outcomes in a Series of 20 Patients

Yang¹,

Anand²,

Schwartz³

2013

J Neurol Surg B

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“…The majority of published series reports 60% of asymptomatic patients and 19% of patients with minor disabilities (22). More than half of all patients require hormone replacement following an episode of pituitary tumor apoplexy; therefore, endocrine monitoring is essential.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous remission of acromegaly: apoplexy mimicking meningitis or meningitis as a cause of apoplexy?

Villar-Taibo

Ballesteros-Pomar

Vidal-Casariego

et al. 2014

Arq Bras Endocrinol Metab

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SUMMARYPituitary apoplexy is a rare but potentially life-threatening clinical syndrome characterized by ischemic infarction or hemorrhage into a pituitary tumor. The diagnosis of pituitary tumor apoplexy is frequently complicated because of the nonspecific nature of its signs and symptoms, which can mimic different neurological processes, including meningitis. Several factors have been associated with apoplexy, such as dopamine agonists, radiotherapy, or head trauma, but meningitis is a rarely reported cause. We describe the case of a 51-year-old woman with acromegaly due to a pituitary macroadenoma. Before surgical treatment, she arrived at Emergency with fever, nausea, vomiting and meningismus. Symptoms and laboratory tests suggested bacterial meningitis, and antibiotic therapy was initiated, with quick improvement. A computerized tomography (CT) scan at admission did not reveal any change in pituitary adenoma, but a few weeks later, magnetic resonance imaging (MRI) showed data of pituitary apoplexy with complete disappearance of the adenoma. Currently, her acromegaly is cured, but she developed hypopituitarism and diabetes insipidus following apoplexy. We question whether she really experienced meningitis leading to apoplexy or whether apoplexy was misinterpreted as meningitis. In conclusion, the relationship between meningitis and pituitary apoplexy may be bidirectional. Apoplexy can mimic viral or bacterial meningitis, but meningitis might cause apoplexy, as well. This fact highlights the importance of differential diagnosis when evaluating patients with pituitary adenomas and acute neurological symptoms. Arq Bras Endocrinol Metab. 2014;58(1):76-80 SUMÁRIO A apoplexia é uma síndrome clínica rara, mas potencialmente fatal, caracterizada por infarto isquê-mico ou hemorragia em um tumor pituitário. O diagnóstico de apoplexia de tumor pituitário é frequentemente complicado pela natureza inespecífica dos seus sinais e sintomas, que podem simular diferentes processos neurológicos, incluindo a meningite. Vários fatores estão associados com a apoplexia, como o uso de agonistas dopaminérgicos, radioterapia ou trauma da cabeça, mas a meningite foi raramente relatada. Descrevemos o caso de uma mulher de 51 anos de idade com acromegalia por um macroadenoma pituitário. Antes do tratamento cirúrgico, ela foi trazida ao pronto--socorro com febre, náusea, vômitos e meningismo. Os sintomas e análises laboratoriais sugeriram meningite bacteriana e o tratamento com antibióticos foi iniciado, com melhora rápida dos sintomas. Uma tomografia computadorizada (CT) na admissão ao hospital não revelou nenhuma alteração no adenoma pituitário, mas algumas semanas depois uma ressonância magnética (MRI) mostrou informações de apoplexia pituitária, com desaparecimento completo do adenoma. Atualmente, a acromegalia está curada, mas ela desenvolveu hipopituitarismo e diabetes insipidus depois da apoplexia. Questionamo-nos se a paciente realmente apresentou meningite que levou à apoplexia ou se a apoplexia foi mal interpretada como sendo me...

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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.…”

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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Pituitary Apoplexy

Cited by 231 publications

References 32 publications

Endoscopic Endonasal Transsphenoidal Treatment of Pituitary Apoplexy: Outcomes in a Series of 20 Patients

Endoscopic Endonasal Transsphenoidal Treatment of Pituitary Apoplexy: Outcomes in a Series of 20 Patients

Spontaneous remission of acromegaly: apoplexy mimicking meningitis or meningitis as a cause of apoplexy?

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

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