Pituitary Apoplexy After Cardiac Surgery

Hidiroğlu, Mete; Küçüker, Aslıhan; Uçaroğlu, Erhan Renan; Küçüker, Şeref Alp; Şener, Erol

doi:10.1016/j.athoracsur.2009.09.038

Cited by 20 publications

(13 citation statements)

References 8 publications

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“…Pituitary tumour apoplexy is a rare, but recognized complication of cardiac surgery [12,21,22]. Its clinical presentation comprises headache, visual disturbances and sudden-onset hypopituitarism up to Addisonian crisis [12,22].…”

Section: Discussionmentioning

confidence: 99%

Can cardiac surgery cause hypopituitarism?

et al. 2011

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Apoplexy of pituitary adenomas with subsequent hypopituitarism is a rare but well recognized complication following cardiac surgery. The nature of cardiac on-pump surgery provides a risk of damage to the pituitary because the vascular supply of the pituitary is not included in the cerebral autoregulation. Thus, pituitary tissue may exhibit an increased susceptibility to hypoperfusion, ischemia or intraoperative embolism. After on-pump procedures, patients often present with physical and psychosocial impairments which resemble symptoms of hypopituitarism. Therefore, we analyzed whether on-pump cardiac surgery may cause pituitary dysfunction also in the absence of pre-existing pituitary disease. Twenty-five patients were examined 3-12 months after on-pump cardiac surgery. Basal hormone levels for all four anterior pituitary hormone axes were measured and a short synacthen test and a growth hormone releasing hormone plus arginine (GHRH-ARG)-test were performed. Quality of life (QoL), depression, subjective distress for a specific life event, sleep quality and fatigue were assessed by means of self-rating questionnaires. Hormonal alterations were only slight and no signs of anterior hypopituitarism were found except for an insufficient growth hormone rise in two overweight patients in the GHRH-ARG-test. Psychosocial impairment was pronounced, including symptoms of moderate to severe depression in 9, reduced mental QoL in 8, dysfunctional coping in 6 and pronounced sleep disturbances in 16 patients. Hormone levels did not correlate with psychosocial impairment. On-pump cardiac surgery did not cause relevant hypopituitarism in our sample of patients and does not serve to explain the psychosocial symptoms of these patients.

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Section: Discussionmentioning

confidence: 99%

Can cardiac surgery cause hypopituitarism?

et al. 2011

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“…(9) Carotid artery occlusion may cause hemiparesis, and hypothalamic compression may cause sympathetic autoregulation changes. (3) There are roughly 20 reported cases of pituitary apoplexy occurring after cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

“…The dynamics of cardiopulmonary bypass (CPB) contribute to the sudden expansion of silent pituitary adenomas. (3) A range of clinical appearances for pituitary apoplexy has been described, including a lack of clinical symptoms, the presence of headache, a sudden decline in mental status, visual alteration, acute adrenal crisis (i.e. Addisonian crisis), ophthalmoplegia, and third cranial nerve palsy and/or ptosis.…”

Section: Introductionmentioning

confidence: 99%

Coronary artery bypass grafting in a patient with pituitary adenoma: can alertness prevent tragedy?

Shah

Hrabovsky²

2014

smedj

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“…Moreover, cardiac surgery requires anticoagulation for cardiopulmonary bypass. [105][106][107][108] Nonpituitary tumors account for approximately 10% of all cases of PI, while the remaining 30% are due to brain damage secondary to traumatic brain injury, irradiation, and hemorrhagic/ischemic stroke. Immune checkpoint inhibitors (ICI) used in oncology are an emerging cause of PI.…”

Section: Pathophysiologymentioning

confidence: 99%

Metabolic and Endocrine Challenges

Bonicolini

Parekh

Thein

et al. 2020

Semin Respir Crit Care Med

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This review aims to provide an overview of metabolic and endocrine challenges in the setting of intensive care medicine. These are a group of heterogeneous clinical conditions with a high degree of overlap, as well as nonspecific signs and symptoms. Several diseases involve multiple organ systems, potentially causing catastrophic dysfunction and death. In the majority of cases, endocrine challenges accompany other organ failures or manifest as a complication of prolonged intensive care unit stay and malnutrition. However, when endocrine disorders present as an isolated syndrome, they are a rare and extreme manifestation. As they are uncommon, these can typically challenge both with diagnosis and management. Acute exacerbations may be elicited by triggers such as infections, trauma, surgery, and hemorrhage. In this complex scenario, early diagnosis and prompt treatment require knowledge of the specific endocrine syndrome. Here, we review diabetic coma, hyponatremia, hypercalcemia, thyroid emergencies, pituitary insufficiency, adrenal crisis, and vitamin D deficiency, highlighting diagnostic tools and tricks, and management pathways through defining common clinical presentations.

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Pituitary Apoplexy After Cardiac Surgery

Cited by 20 publications

References 8 publications

Can cardiac surgery cause hypopituitarism?

Can cardiac surgery cause hypopituitarism?

Coronary artery bypass grafting in a patient with pituitary adenoma: can alertness prevent tragedy?

Metabolic and Endocrine Challenges

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