Pituitary apoplexy presenting as myocardial infarction

Gupta, Vishal; Patil, Sudarshan; Raval, Dhiren; Gopani, Pratik

doi:10.4103/2230-8210.129119

Cited by 3 publications

(7 citation statements)

References 9 publications

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“…Therefore, reductions of oxidative stress by current pharmacotherapy prevent activation of harmful 16 kDa prolactin subfraction which per se reduces the body stress response and then reduction of serum prolactin levels during the recovery period from MI. [ 23 ]…”

Section: Discussionmentioning

confidence: 99%

Assessment of serum prolactin levels in acute myocardial infarction: The role of pharmacotherapy

Al-Kuraishy¹,

Al-Gareeb²,

Awad³

et al. 2016

Indian J Endocr Metab

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Background:Hyperprolactinemia may reflect neuroendocrine stress reaction against acute coronary syndromes.Aim:The aim of the present study was evaluation of the serum prolactin level in the acute myocardial infarction (MI) regarding the current pharmacotherapy in management of MI.Setting and Design:Cross-sectional clinical based study.Subjects and Methods:This cross-sectional clinical study involved all patients with acute MI in a coronary care unit, a total number of 44 patients (45% males and 55% females) with age ranged from 40 to 75 years. A full history for modifiable risk factors and current therapy with aspirin, clopidogrel and or metformin, all patients are nonsmokers. The anthropometric measurements; for estimations of body mass index (kg/m2), electrocardiography was obtained. Fasting blood samples were taken in the morning from all patients and the sera used for estimations of routine investigation and determination of ischemic cardiac biomarkers like cardiac troponin I (cTnI) and serum prolactin level.Results:This study shows a significant increase in the serum prolactin in acute MI as compared with the control. In acute MI serum cTnI elevation was correlated with serum prolactin increments. In metformin-treated group, there was a lowest prolactin serum level.Conclusions:Serum prolactin level increased in acute MI, and positively correlated with cardiac troponin level and reflects underlying cardiovascular complications.

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Section: Discussionmentioning

confidence: 99%

Assessment of serum prolactin levels in acute myocardial infarction: The role of pharmacotherapy

Al-Kuraishy¹,

Al-Gareeb²,

Awad³

et al. 2016

Indian J Endocr Metab

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“…In accordance with medical literature, we found a male predominance (male-to-female ratio of 1.76). The mean age of patients was 50.52 years, the youngest was 9, and the oldest was 85 years [ 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , ...…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

“…Other common symptoms include nausea and vomiting, either with a neurological or endocrine component (acute secondary adrenal insufficiency) [ 25 , 29 , 30 , 33 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , …”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

“…The most frequent cranial nerve affected was the oculomotor nerve, but rarely, patients also presented with abducens [ 25 , 44 , 77 , 81 , 84 , 85 , 91 , 98 , 113 , 120 , 121 , 123 , 124 , 128 , 142 , 168 , 174 , 182 , 192 , 207 ] and trochlear [ 25 , 63 , 81 , 84 , 102 , 121 , 123 , 124 , 149 , 168 , 182 , 209 ] nerves palsies. Optic chiasm compression was specified in 18 articles [ 32 , 33 , 46 , 55 , 62 , 63 , 65 , 69 , 80 , 123 , 125 , 169 , 177 , 185 , 186 , 191 , 192 , …”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

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Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

et al. 2023

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Various complications of pituitary neuroendocrine tumors (PitNET) are reported, and an intratumor hemorrhage or infarct underlying pituitary apoplexy (PA) represents an uncommon, yet potentially life-threatening, feature, and thus early recognition and prompt intervention are important. Our purpose is to overview PA from clinical presentation to management and outcome. This is a narrative review of the English-language, PubMed-based original articles from 2012 to 2022 concerning PA, with the exception of pregnancy- and COVID-19-associated PA, and non-spontaneous PA (prior specific therapy for PitNET). We identified 194 original papers including 1452 patients with PA (926 males, 525 females, and one transgender male; a male-to-female ratio of 1.76; mean age at PA diagnostic of 50.52 years, the youngest being 9, the oldest being 85). Clinical presentation included severe headache in the majority of cases (but some exceptions are registered, as well); neuro-ophthalmic panel with nausea and vomiting, meningism, and cerebral ischemia; respectively, decreased visual acuity to complete blindness in two cases; visual field defects: hemianopia, cranial nerve palsies manifesting as diplopia in the majority, followed by ptosis and ophthalmoplegia (most frequent cranial nerve affected was the oculomotor nerve, and, rarely, abducens and trochlear); proptosis (N = 2 cases). Risk factors are high blood pressure followed by diabetes mellitus as the main elements. Qualitative analysis also pointed out infections, trauma, hematologic conditions (thrombocytopenia, polycythemia), Takotsubo cardiomyopathy, and T3 thyrotoxicosis. Iatrogenic elements may be classified into three main categories: medication, diagnostic tests and techniques, and surgical procedures. The first group is dominated by anticoagulant and antiplatelet drugs; additionally, at a low level of statistical evidence, we mention androgen deprivation therapy for prostate cancer, chemotherapy, thyroxine therapy, oral contraceptives, and phosphodiesterase 5 inhibitors. The second category includes a dexamethasone suppression test, clomiphene use, combined endocrine stimulation tests, and a regadenoson myocardial perfusion scan. The third category involves major surgery, laparoscopic surgery, coronary artery bypass surgery, mitral valvuloplasty, endonasal surgery, and lumbar fusion surgery in a prone position. PA in PitNETs still represents a challenging condition requiring a multidisciplinary team from first presentation to short- and long-term management. Controversies involve the specific panel of risk factors and adequate protocols with concern to neurosurgical decisions and their timing versus conservative approach. The present decade-based analysis, to our knowledge the largest so far on published cases, confirms a lack of unanimous approach and criteria of intervention, a large panel of circumstantial events, and potential triggers with different levels of statistical significance, in addition to a heterogeneous clinical picture (if any, as seen in subacute PA) and a spectrum of evolution that varies from spontaneous remission and control of PitNET-associated hormonal excess to exitus. Awareness is mandatory. A total of 25 cohorts have been published so far with more than 10 PA cases/studies, whereas the largest cohorts enrolled around 100 patients. Further studies are necessary.

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“…The intricate relationship of the pituitary and heart is well-known. While hypopituitarism makes the patients prone to cardiovascular (CV) diseases and may present with predominant CV manifestations,[ 1 2 3 4 5 6 7 8 9 10 ] several CV disorders are associated with perturbations of single or multiple hypothalamic–pituitary–end-organ axes either as a physiologic response[ 11 12 13 14 ] or pathological consequences. [ 15 16 ] We present a case of acute myocardial infarction (AMI) followed by left ventricular failure (LVF) and cardiogenic shock unresponsive to vasopressor therapy and complicated by panhypopituitarism and empty sella (ES).…”

Section: Introductionmentioning

confidence: 99%

Panhypopituitarism in Acute Myocardial Infarction

Ghosh

Chatterjee

Roy

et al. 2021

Annals of African Medicine

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While hypopituitarism is known to be associated with increased cardiovascular morbidity and mortality, panhypopituitarism as a complication of myocardial infarction (MI) is very rare. Here, we report a case of rapidly developing empty sella syndrome with florid manifestations of panhypopituitarism after MI (due to critical stenosis in the left anterior descending artery) complicated by cardiogenic shock in a 65-year-old man. The patient was initially stabilized with conservative management of non-ST-elevated MI and cardiogenic shock, but after initial improvement, he again deteriorated with refractory shock (not adequately responding to vasopressors), seizures, hypoglycemia, hyponatremia, hyperkalemia, and metabolic acidosis. After ruling out recurrent cardiogenic shock or other causes of refractory hypotension, panhypopituitarism was diagnosed with the help of hormonal assays and imaging. With no prior evidence of hypopituitarism, we suspect that panhypopituitarism developed due to acute pituitary apoplexy secondary to initial cardiogenic shock. The patient was successfully survived by the emergency endocrine management followed by secondary coronary angioplasty.

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Pituitary apoplexy presenting as myocardial infarction

Cited by 3 publications

References 9 publications

Assessment of serum prolactin levels in acute myocardial infarction: The role of pharmacotherapy

Assessment of serum prolactin levels in acute myocardial infarction: The role of pharmacotherapy

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

Panhypopituitarism in Acute Myocardial Infarction

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