Pituitary apoplexy after somatostatin analogue administration: coincidental or causative?

Bakiri, F; Herrera, Javier; Riestra, María Luisa; Perrichot, Olivier; Pertierra, Joaquin; Bruno, Oscar D.; Brue, Thierry; Castinetti, Frédéric

doi:10.1111/cen.12339

Cited by 8 publications

(5 citation statements)

References 5 publications

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“…The third case was mentioned in series of acromegaly, but no details were available. Bakiri et al [ 8 ] reported four cases of pituitary apoplexy associated with lanreotide autogel preparation. Also, in their case series, all four patients had associated risk factors for apoplexy.…”

Section: Discussionmentioning

confidence: 99%

Pituitary apoplexy causing spontaneous remission of acromegaly following long-acting octreotide therapy: a rare drug side effect or just a coincidence

Kumar

Sharma

2016

Oxf Med Case Rep

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Pituitary apoplexy is characterized by abrupt onset of haemorrhage or non-haemorrhagic infarction of a pituitary adenoma. The clinical features include acute onset severe headache, visual field defects, meningeal irritation, ophthalmoplegia and hypopituitarism. The pituitary apoplexy may be clinically silent in ∼25% of patients. We report a case of acromegaly due to pituitary macroadenoma. The patient was started on long-acting octreotide therapy. On 3-month follow-up, the patient showed clinical and biochemical remission and the magnetic resonance imaging (MRI) of the brain showed subclinical haemorrhage and resolution of tumour. The octreotide therapy was stopped. On 6-month follow-up, the patient was still in remission and the MRI of brain revealed non-enhancing mixed intensities haemorrhagic and cystic areas of the pituitary gland. In our patient, whether spontaneous remission of acromegaly due to subclinical pituitary haemorrhage was coincidental or due to long-acting octreotide therapy is still a dilemma. We report this case because of rarity and clinical importance of this unusual occurrence.

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Section: Discussionmentioning

confidence: 99%

Pituitary apoplexy causing spontaneous remission of acromegaly following long-acting octreotide therapy: a rare drug side effect or just a coincidence

Kumar

Sharma

2016

Oxf Med Case Rep

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“…Esta complicación se ha descrito, además, con la utilización de las pruebas dinámicas endocrinas, que incluyen la prueba de tolerancia a la insulina, de la hormona liberadora de TSH, de la liberadora de gonadotropinas, de la liberadora de ACTH y de la hormona del crecimiento. La complicación ocurrió en el lapso de 2 horas después de la prueba dinámica en el 83% de los casos, especialmente cuando se utilizaron combinaciones de estos estímulos (42)(43)(44)(45) . El problema se presenta debido a un desbalance entre la exigente demanda metabólica producida por estos factores endocrinos y la respuesta anormal de unas arteriolas previamente comprometidas en su estructura.…”

Section: Causas Predisponentes Y Precipitantesunclassified

“…El problema se presenta debido a un desbalance entre la exigente demanda metabólica producida por estos factores endocrinos y la respuesta anormal de unas arteriolas previamente comprometidas en su estructura. Por estos hechos se ha sugerido la no realización de pruebas dinámicas con TRH, con las hormonas liberadoras de gonadotropinas y de hormonas del crecimiento en presencia de un macroadenoma hipo�isario (43)(44)(45) . Los estudios dinámicos pueden aumentar las necesidades metabólicas del tumor y precipitar la AP en presencia de una circulación vascular de�iciente.…”

Section: Causas Predisponentes Y Precipitantesunclassified

Diagnóstico y manejo de la apoplejía hipofisaria

Orrego

León

2019

Rev.ACE

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La apoplejía hipofisaria (o pituitaria) se caracteriza por necrosis isquémica o hemorragia en el interior de un tumor hipofisario. Aunque puede presentarse espontáneamente en adenomas preexistentes, hay factores precipitantes como la hipertensión, embarazo, bromocriptina, pruebas dinámicas endocrinas realizadas preoperatoriamente, radioterapia sobre la hipófisis o cirugía cardíaca. La apoplejía hipofisaria clásica es una emergencia médica, y se debe administrar hidrocortisona rápidamente para salvar la vida del paciente. Cursa con cefalea súbita, vómito, irritación meníngea, cambios en la agudeza visual y a veces nivel de conciencia reducido. Pueden verse o no signos neurológicos, en el primer caso con compromiso de los pares craneanos segundo, tercero, cuarto y sexto. Las pruebas imagenológicas, en especial la resonancia magnética, son indispensables. Se debate si el tratamiento debe ser quirúrgico o conservador, dependiendo de la progresión y agresividad de los síntomas. El tratamiento quirúrgico consiste en la descompresión selar transesfenoidal inmediata y terapia de reemplazo con dosis elevadas de corticoides. Sin embargo, se discute si el manejo conservador de observación es una alternativa adecuada cuando mejoran o desaparecen los síntomas y hay estabilidad.

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“…Macroprolactinoma and female gender were more associated with hemorrhage (19). There are some case reports of PA related to medical treatment in acromegaly: three cases on octreotide and four cases receiving lanreotide (20).…”

Section: Physiopathologymentioning

confidence: 99%

Pituitary apoplexy: pathophysiology, diagnosis and management

Glezer

Bronstein

2015

Arch. Endocrinol. Metab.

115

108

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Pituitary apoplexy is characterized by sudden increase in pituitary gland volume secondary to is chemia and/or necrosis, usually in a pituitary adenoma. Most cases occur during the 5 th decade of life, predominantly in males and in previously unknown clinically non functioning pituitary adeno mas. There are some predisposing factors as arterial hypertension, anticoagulant therapy and major surgery. Clinical picture comprises headache, visual impairment, cranial nerve palsies and hypopitui tarism. Most cases improve with both surgical and expectant management and the best approach in the acute phase is still controversial. Surgery, usually by transsphenoidal route, is indicated if cons ciousness and/or vision are impaired, despite glucocorticoid replacement and electrolyte support. Pi tuitary function is impaired in most patients before apoplexy and ACTH deficiency is common, which makes glucocorticoid replacement needed in most cases. Pituitary deficiencies, once established, usually do not recover, regardless the treatment. Sellar imaging and endocrinological function must be periodic reevaluated. Arch Endocrinol Metab. 2015;59(3):259-64

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Pituitary apoplexy after somatostatin analogue administration: coincidental or causative?

Cited by 8 publications

References 5 publications

Pituitary apoplexy causing spontaneous remission of acromegaly following long-acting octreotide therapy: a rare drug side effect or just a coincidence

Pituitary apoplexy causing spontaneous remission of acromegaly following long-acting octreotide therapy: a rare drug side effect or just a coincidence

Diagnóstico y manejo de la apoplejía hipofisaria

Pituitary apoplexy: pathophysiology, diagnosis and management

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