Pituitary Apoplexy

Russell, Steven J.; Miller, Karen K.

doi:10.1007/978-1-59745-264-9_19

Cited by 4 publications

(3 citation statements)

References 97 publications

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“…About half of the patients report diplopia, and some of them have ocular paresis due to functional impairment of the third, sixth, or, less frequently, fourth cranial nerve [11, 51, 54, 69, 70]. The third cranial nerve is the most frequently affected, resulting in ptosis, mydriasis, and limited eye movements in adduction [54, 71, 72]. Visual field evaluation, especially its on-going evolution, ideally performed by an ophthalmologist or neuroophthalmologist, is critical not only for the diagnosis but also for planning the therapeutic approach modalities and, to some extent, for predicting prognosis.…”

Section: Clinical Featuresmentioning

confidence: 99%

Multidisciplinary Management of Pituitary Apoplexy

Albani

Ferraú

Angileri

et al. 2016

International Journal of Endocrinology

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Pituitary apoplexy is a rare clinical syndrome due to ischemic or haemorrhagic necrosis of the pituitary gland which complicates 2–12% of pituitary tumours, especially nonfunctioning adenomas. In many cases, it results in severe neurological, ophthalmological, and endocrinological consequences and may require prompt surgical decompression. Pituitary apoplexy represents a rare medical emergency that necessitates a multidisciplinary approach. Modalities of treatment and times of intervention are still largely debated. Therefore, the management of patients with pituitary apoplexy is often empirically individualized and clinical outcome is inevitably related to the multidisciplinary team's skills and experience. This review aims to highlight the importance of a multidisciplinary approach in the management of pituitary apoplexy and to discuss modalities of presentation, treatment, and times of intervention.

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Section: Clinical Featuresmentioning

confidence: 99%

Multidisciplinary Management of Pituitary Apoplexy

Albani

Ferraú

Angileri

et al. 2016

International Journal of Endocrinology

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“…Classical symptoms include headache, visual impairment, cranial nerve palsy and hypopituitarism in the acute phase [7,8]. The mortality of transsphenoidal surgery in patients with pituitary apoplexy in the acute phase is almost twice as high (1.6-1.9 %) as seen in "classical" transsphenoidal surgery for pituitary adenomas (0.4-0.9 %) [9]. In consequence to the apoplexy, up to 80 % of patients develop partial or panhypopituitarism [1], whereas the resulting acute corticotroph insufficiency causes the majority of deaths associated with the disease.…”

Section: Introductionmentioning

confidence: 99%

“…Previous studies could not demonstrate a benefit of surgical over conservative treatment for patients suffering from apoplexy without visual field deficits or mild forms with only marginally impaired clinical status or neuro-endocrine functions [15][16][17]. One smallsized study demonstrated recovery of the pituitary gland after immediate operative therapy, but this finding could not be corroborated in a larger trial with acute operative intervention [9,13]. Current guidelines suggest that surgery should be performed within 7 days after first onset of symptoms [1], whereas this recommendation is based on improved neuro-ophthalmic outcomes in several case series with early surgery [12,18,19].…”

Section: Introductionmentioning

confidence: 99%

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

Lammert

Walter

Giordano

et al. 2018

Exp Clin Endocrinol Diabetes

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Pituitary Apoplexy

et al. 2015

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Pituitary apoplexy, a rare clinical syndrome secondary to abrupt hemorrhage or infarction, complicates 2%-12% of pituitary adenomas, especially nonfunctioning tumors. Headache of sudden and severe onset is the main symptom, sometimes associated with visual disturbances or ocular palsy. Signs of meningeal irritation or altered consciousness may complicate the diagnosis. Precipitating factors (increase in intracranial pressure, arterial hypertension, major surgery, anticoagulant therapy or dynamic testing, etc) may be identified. Corticotropic deficiency with adrenal insufficiency may be life threatening if left untreated. Computed tomography or magnetic resonance imaging confirms the diagnosis by revealing a pituitary tumor with hemorrhagic and/or necrotic components. Formerly considered a neurosurgical emergency, pituitary apoplexy always used to be treated surgically. Nowadays, conservative management is increasingly used in selected patients (those without important visual acuity or field defects and with normal consciousness), because successive publications give converging evidence that a wait-and-see approach may also provide excellent outcomes in terms of oculomotor palsy, pituitary function and subsequent tumor growth. However, it must be kept in mind that studies comparing surgical approach and conservative management were retrospective and not controlled.

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Pituitary Apoplexy

Cited by 4 publications

References 97 publications

Multidisciplinary Management of Pituitary Apoplexy

Multidisciplinary Management of Pituitary Apoplexy

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

Pituitary Apoplexy

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