Pituitary Apoplexy

Abstract

Pituitary apoplexy is an uncommon complication of pituitary adenomas. The syndrome is manifest by an abrupt onset of signs and symptoms associated with infarction or hemorrhage into a preexisting pituitary adenoma. The lesion swells and expands, leading to compression of local suprasellar and parasellar structures. The incidence of pituitary apoplexy ranges from 1 to 20% in surgically verified pituitary adenomas, with a slight male predominance. Most frequently, pituitary apoplexy occurs in previously undiagnosed pituitary adenomas. The diagnosis may often be confused with aneurysmal subarachnoid hemorrhage or meningitis. When pituitary apoplexy is misdiagnosed and left untreated, the neurological sequelae can be devastating, resulting in permanent blindness, coma, or death. Glucocorticoid administration and transsphenoidal decompression remain the mainstay of treatment in this acute event.Objectives: Upon completion of this article, the reader should be able to identify the clinical manifestations of pituitary apoplexy, be familiar with the mechanisms of pathogenesis, and understand the importance of rapid diagnosis and treatment of pituitary apoplexy.

Detecting early-warning signals for sudden deterioration of complex diseases by dynamical network biomarkers

“…This is well known in dynamical systems theory as a bifurcation that results in a qualitative transition in states or attractors78. Recently, evidence has been found suggesting that the similar phenomena exist in clinical medicine, that is, during the progression of many complex diseases, e.g., in chronical diseases such as cancer, the deterioration is not necessarily smooth but abrupt910111213. In other words, there exists a sudden catastrophic shift during the process of gradual health deterioration that results in a drastic transition to a disease state.…”

Identifying critical transitions and their leading biomolecular networks in complex diseases

“…There is usually a sudden health deterioration during gradual progression of many chronic diseases, such as prostate cancer1, asthma attacks2, epileptic seizures3, and others45678. This critical phenomenon generally results in a drastic or a qualitative transition in the focal system or network from a normal state to a diseased state, which corresponds to a so-called bifurcation point in dynamical systems theory910.…”

Delayed postoperative pituitary apoplexy after endoscopic transsphenoidal resection of a giant pituitary macroadenoma

“…A similar presentation has been reported in association with pergolide. 2 The aetiology of chronic oedema is complex and frequently regarded as a complication of a deficient lymphatic system in the case of lymphoedema. 3 Husmaan et al 4 reported lymphoedema associated with lymphatic microangiopathy, and increased lymphatic and interstitial pressure in a patient with PD.…”

“…[1][2][3] Increased intrasellar pressure due to swelling and expansion of the lesion may cause compression of adjacent parasellar and suprasellar structures such as the cavernous sinus and optic chiasm, respectively. Patients with PA typically present with sudden onset of excruciating headache, nausea, vomiting, diplopia, ophthalmoplegia, and visual impairment.…”

“…[1][2][3][4][5] Failure to diagnose and treat PA in a timely fashion may result in permanent blindness and coma. Immediate corticosteroid administration followed by transsphenoidal decompression is the treatment of choice in most patients with PA. [1][2][3]5,6 Postoperative pituitary apoplexy (PPA) following resection of a pituitary adenoma is rare but has been reported to occur in giant pituitary tumors (>4 cm in greatest diameter) after subtotal resection within the immediate postoperative period (within 12 hours). 7 All of the previously reported patients demonstrated acute neurologic worsening with eventual fatal outcomes due to massive tumor swelling, intratumoral hemorrhage and infarction within the residual tumor.…”