Pituitary Apoplexy: Should Endoscopic Surgery Be the Gold Standard?

Teixeira, Joaquim Cruz; Lavrador, José Pedro; Simão, Diogo; Miguéns, José

doi:10.1016/j.wneu.2017.12.103

Cited by 19 publications

(19 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The most common precipitating factors are pituitary stimulation, surgery (in particular coronary artery surgery), and coagulopathy (16). Thus, antithrombotic/anticoagulant therapy may have an important role as precipitating factor (15), and in the current study 21% of the patients were on such treatment. Over time the new, easier controllable anticoagulants that have become in use probably also decrease the number of patients at risk of a pituitary hemorrhage.…”

Section: Discussionmentioning

confidence: 60%

“…However, pituitary deficiencies, once established, usually do not recover (14). Of interest, one study showed a better endocrinologic outcome in patients with pituitary apoplexy who underwent endoscopic pituitary surgery compared to patients who were treated conservatively (15). However, our patients with pituitary deficiencies did not recover irrespective whether they had endoscopic pituitary surgery or not.…”

Section: Discussionmentioning

confidence: 68%

See 1 more Smart Citation

Pituitary Apoplexy: A Retrospective Study of 33 Cases From a Single Center

2021

View full text Add to dashboard Cite

PurposeAcute symptomatic pituitary apoplexy is a rare and potentially life-threatening condition. However, pituitary apoplexy can also present with milder symptoms and stable hemodynamics. Due to the rarity of this inhomogeneous condition, clinical studies are important to increase the knowledge.MethodsWe retrospectively reviewed all consecutive cases of pituitary apoplexy being admitted between January 1st, 2005 and December 31st, 2019 at the Karolinska University Hospital, Stockholm, Sweden, for symptoms, results of magnetic resonance (MRI), biochemistry, management and mortality.ResultsThirty-three patients were identified with pituitary apoplexy, 18 were men (55%) and mean age was 46.5 (17.2) years. The incidence of symptomatic pituitary apoplexy was 1.6 patients/year (0.76 patients/1,000,000 inhabitants/year). The majority presented with headache (n=27, 82%) and hormonal deficiencies (n=18, 55%), which were most frequent in men. ACTH deficiency was present in nine patients (27% but 50% of those with hormonal deficiencies). All had the characteristic findings on MRI. Only three patients (9%) required acute pituitary surgery, while eight were operated after more than one week. Seven (21%) were on antithrombotic therapy. None of the patients died in the acute course. During follow-up (7.6 ± 4.3 years) none of the hormonal deficiencies regressed and 3 patients died from non-related causes.ConclusionOur study confirmed the rarity and the symptoms of this condition. Surprisingly, only 3 patients needed acute neurosurgical intervention, perhaps due to milder cases and a general intensified treatment of precipitating factors. An early awareness and in severe cases decision on pituitary surgery is of utmost importance to avoid severe complications.

show abstract

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 68%

Pituitary Apoplexy: A Retrospective Study of 33 Cases From a Single Center

2021

View full text Add to dashboard Cite

show abstract

“…Tumor size regression is directly related to better ophthalmologic and endocrinologic outcomes [ 17 , 18 ]. Early intervention may be able to reverse or partially reverse pituitary function while preserving the third CN function [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Pituitary apoplexy presenting as isolated third cranial nerve palsy: case series

Shrestha

Bishokarma

Rayamajhi

et al. 2022

Journal of Surgical Case Reports

View full text Add to dashboard Cite

Pituitary apoplexy (PA) is caused by a sudden increase in pressure in the pituitary region due to acute hemorrhage, infarction or necrosis. PA can also be caused by restricting blood supply to the nerve due to compression of the internal carotid artery. Acute third cranial nerve palsy (third CN) secondary to PA is a rare medical emergency caused by bleeding within a growing mass within the sella turcica. We presented two cases of PA with isolated third CN palsy treated with transsphenoidal pituitary decompression. PA is therefore an important differential diagnosis to consider in patients with isolated third nerve palsy. The prognosis for isolated third nerve palsy in PA appeared successful, with variable recovery from medical and surgical intervention.

show abstract

“…PA was almost universally considered a neurosurgical emergency in the past, but reports of spontaneous clinical recovery and/or tumor disappearance have led some specialists to adopt a conservative approach in select cases (those without visual acuity or field defects and with normal consciousness). 118 Independent of severe or mild PA clinical features, corticotropic deficiency is almost always present, and can be lifethreatening. As such, corticosteroids should be administered as soon as possible to all patients at the time of diagnosis.…”

Section: Managementmentioning

confidence: 99%

Metabolic and Endocrine Challenges

Bonicolini

Parekh

Thein

et al. 2020

Semin Respir Crit Care Med

View full text Add to dashboard Cite

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.

show abstract

Pituitary Apoplexy: Should Endoscopic Surgery Be the Gold Standard?

Cited by 19 publications

References 21 publications

Pituitary Apoplexy: A Retrospective Study of 33 Cases From a Single Center

Pituitary Apoplexy: A Retrospective Study of 33 Cases From a Single Center

Pituitary apoplexy presenting as isolated third cranial nerve palsy: case series

Metabolic and Endocrine Challenges

Contact Info

Product

Resources

About