Pituitary Apoplexy After Joint Arthroplasty

Goel, Vivek; Debnath, Ujjwal K.; Singh, Jagmohan; Brydon, Howard L.

doi:10.1016/j.arth.2008.06.021

Cited by 13 publications

(8 citation statements)

References 13 publications

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“…Thus, we consider the orthopedic surgery as the primary event, being a procedure a priori known to be accompanied by a large blood loss that could lead to ischemia by hypoperfusion, and/or association of other factors, as intraoperative or postoperative hypotension related to anesthesia, anticoagulation and/or fat/air/ bone marrow microemboli (3,(5)(6)(7).…”

Section: Discussionmentioning

confidence: 99%

“…There are patients that present only ischemic infarction without hemorrhage, while others only primary hemorrhage. The general consensus is that the pituitary apoplexy after surgery is caused by a multitude of factors that include perioperative hypotension related to anesthesia or hypovolemia, anticoagulation, and microemboli (fat, air, bone marrow or cement) (5)(6)(7)(8).…”

Section: Introductionmentioning

confidence: 99%

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Central Hypothyroidism in Severe Sepsis

et al. 2019

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Objective. A partial or complete deficiency of hormone secretion by pituitary gland (hypopituitarism) is commonly seen after a pituitary apoplexy caused by an infarction of a pituitary adenoma or pituitary hyperplasia (as in Sheehan's syndrome). Hypopituitarism may also follow surgery, when hypovolemia, anticoagulation, fat/ air/bone marrow microemboli can provoke a pituitary infarction/hemorrhage. Other causes of abrupt hypophyseal hypoperfusion, as hypovolemia during a septic shock, could also contribute. In the last mentioned situation, due to the complex endocrine-immune interrelation, sepsis could be masked and improperly managed.Case report. We report a case of a 72 years-old Caucasian woman, previously healthy, who underwent an orthopedic surgery for a femoral fracture. This event apparently triggered a central-origin hypothyroidism, misinterpreted as "post-surgical psychosis", which, in turn, masked a symptomatology of a subsequent severe sepsis. The patient was admitted in the infectious diseases department with a severe gut-origin sepsis, needing surgery and long course antibiotics. The pituitary insufficiency was reversed.Conclusion. Pituitary apoplexy is an uncommon but potentially life-threatening disease, and could be precipitated by successive events -in our case an orthopedic surgery and a subsequent severe sepsis. It needs recognizing (has intrinsic severity and could mask other serious conditions), treat and monitor (could progress and/or reverse).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Central Hypothyroidism in Severe Sepsis

et al. 2019

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“…The majority of cases occurred following cardiac surgery, especially CABG, 111,[114][115][116][117][118][119][120][121][122][123][124] as well as mitral valve repair, 125 and aortic valve replacement. 126 Pituitary apoplexy was also seen following: abdominal aortic aneurysm repair; 127 liposuction; 128 knee arthroplasty; 129,130 hip arthroplasty; 114,130 spine surgery; 131 cholecystectomy; 132 orchiectomy; 114 and endoscopic sinus surgery. 110 Patients ranged in age from 45 131 to 79 years.…”

Section: Pituitary Apoplexy Literature Reviewmentioning

confidence: 99%

“…137 Risk factors for developing postoperative stroke include: hypertension, diabetes mellitus, renal insufficiency, smoking history, COPD, peripheral vascular disease, cardiac disease, and/or systolic dysfunction. Patients with symptomatic carotid stenosis may be at increased risk of postoperative stroke, including cortical 114 65 M CABG 1 116 57 M CABG 1 116 55 M CABG 1 118 58 M CABG 1 118 65 M CABG 1 118 68 M CABG 1 122 72 M CABG 1 122 64 M CABG 1 123 79 M CABG 1 123 64 M CABG 1 183 77 M CABG 1 183 59 M CABG 1 117 70 M CABG 1 111 60 F CABG 1 119 61 M CABG 1 120 71 M CABG 1 121 60 M CABG 1 115 63 M CABG 1 115 62 M CABG 1 115 55 M CABG 1 125 56 M Mitral valve replacement 1 126 68; gender NA Aortic valve replacement 1 127 73 M Abdominal aortic aneurysm repair 1 129 65 F Knee arthroplasty 1 130 61 M Knee arthroplasty 1 114 72 M Hip arthroplasty 1 130 76 M Hip arthroplasty 1 131 45 M Spine surgery 1 128 50 F Liposuction 1 114 52 M Orchiectomy 1 132 47 M Cholecystectomy 1 110 67 M endoscopic sinus surgery…”

Section: Pathogenesis Risk Factors and Outcomesmentioning

confidence: 99%

Perioperative visual loss in ocular and nonocular surgery

Berg

Harrison

Lee

2010

OPTH

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Incidence estimates for perioperative vision loss (POVL) after nonocular surgery range from 0.013% for all surgeries up to 0.2% following spine surgery. The most common neuro-ophthalmologic causes of POVL are the ischemic optic neuropathies (ION), either anterior (AION) or posterior (PION). We identified 111 case reports of AION following nonocular surgery in the literature, with most occurring after cardiac surgery, and 165 case reports of PION following nonocular surgery, with most occurring after spine surgery or radical neck dissection. There were an additional 526 cases of ION that did not specify if the diagnosis was AION or PION. We also identified 933 case reports of central retinal artery occlusion (CRAO), 33 cases of pituitary apoplexy, and 245 cases of cortical blindness following nonocular surgery. The incidence of POVL following ocular surgery appears to be much lower than that seen following nonocular surgery. We identified five cases in the literature of direct optic nerve trauma, 47 cases of AION, and five cases of PION following ocular surgery. The specific pathogenesis and risk factors underlying these neuro-ophthalmic complications remain unknown, and physicians should be alert to the potential for loss of vision in the postoperative period. Method of literature reviewWe searched the National Library of Medicine's PubMed database with a subsequent review of the accompanying references (last accessed February 8, 2010). The major search words and word combinations included: posterior ischemic optic neuropathy; anterior ischemic optic neuropathy; central retinal artery occlusion; pituitary apoplexy; cortical blindness; optic nerve trauma; postoperative vision loss; postoperative blindness; perioperative vision loss; perioperative blindness; and ocular surgery. In addition, the citations from the above searches were also included. Cases from the non-English literature and cases prior to 1970 were not included. Cases with documented direct surgical trauma to orbital structures other than the optic nerve were not included.

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“…cavernous sinus and neuro-vascular bundle (hence cranial nerve palsies and ophthalmoplegia). 5 Headache occurs secondary to meningeal irritation owing to blood entering the basal cisterns or from dural stretching. Blood in the supra-sellar cistern may provoke chemical meningitis, as has been reported by Wen-Yi et al 6 Restricted visual fields are the result of distension of the optic nerves and chiasm, specifically bitemporal hemi-anopia.…”

Section: Fig 4 Axial T2 Flair Image Shows Reduction In Tumour Volumementioning

confidence: 99%

Acute pituitary apoplexy complicating a pituitary macroadenoma

et al. 2010

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Pituitary apoplexy is a rare but potentially life-threatening condition caused by either haemorrhage or infarction of the pituitary gland. In most cases, a pre-existing pituitary macroadenoma is present. Patients present with the clinical syndrome of headache, visual defects or ophthalmoplegia, altered state of consciousness and variable endocrine deficits. Case historyA 49-year-old man presented to the emergency department with headaches, visual disturbances and severe hypotension. On examination, a left temporal hemianopia was found. His GCS was 15/15 and there were no other cranial nerve deficits. Laboratory investigations revealed decreased cortisol, thyroid stimulating hormone, prolactin, testosterone and adreno-cortico-thyrotropic hormone levels. He was also hyponatraemic.A clinical diagnosis of pituitary apoplexy with severe hypopituitarism was made, and the patient had immediate fluid and electrolyte replacement, hydrocortisone and T4 replacement. The patient was reluctant to undergo surgery and was initially managed with medical therapy. Imaging findingsOn MR investigation, a sella and supra-sella mass showing mixed signal intensity was found (Figs 1 -3). Subsequent imaging to plan for transsphenoidal surgery included a CT scan of the skull base and brain, done 3 months after the initial diagnosis, and it was then discovered that the sella mass had decreased in size. Further MR imaging a week after the CT scan and again 2 months later (Figs 4 -6)

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Pituitary Apoplexy After Joint Arthroplasty

Cited by 13 publications

References 13 publications

Central Hypothyroidism in Severe Sepsis

Central Hypothyroidism in Severe Sepsis

Perioperative visual loss in ocular and nonocular surgery

Acute pituitary apoplexy complicating a pituitary macroadenoma

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