Pituitary Apoplexy: The Role of Atheromatous Emboli

Sussman, Edward B.; Porro, Robert S.

doi:10.1161/01.str.5.3.318

Cited by 30 publications

(6 citation statements)

References 21 publications

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“…Several series have showed a 9 to 15% rate of hemorrhagic degeneration in these tumors 9) . The inherent fragility of tumor blood vessels 2) and atherosclerotic embolization 17) have been proposed as possible mechanisms for hemorrhage and infarction in pituitary adenomas. On the other hand, Sheehan's syndrome or pituitary gland necrosis, is a A B rare complication of postpartum hemorrhage that was initially described in 1937 16) .…”

Section: Discussionmentioning

confidence: 99%

Pituitary Apoplexy Presenting as Isolated Third Cranial Nerve Palsy with Ptosis : Two Case Reports

Cho

Joo

Kim

et al. 2009

J Korean Neurosurg Soc

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Pituitary apoplexy is a clinical syndrome caused by an acute ischemic or hemorrhagic vascular accident involving a pituitary adenoma or an adjacent pituitary gland. Pituitary apoplexy may be associated with a variety of neurological and endocrinological signs and symptoms. However, isolated third cranial nerve palsy with ptosis as the presenting sign of pituitary apoplexy is very rare. We describe two cases of pituitary apoplexy presenting as sudden-onset unilateral ptosis and diplopia. In one case, brain magnetic resonance imaging (MRI) revealed a mass in the pituitary fossa with signs of hemorrhage, upward displacement of the optic chiasm, erosion of the sellar floor and invasion of the right cavernous sinus. In the other case, MRI showed a large area of insufficient enhancement in the anterior pituitary consistent with pituitary infarction or Sheehan's syndrome. We performed neurosurgical decompression via a transsphenoidal approach. Both patients showed an uneventful recovery. Both cases of isolated third cranial nerve palsy with ptosis completely resolved during the early postoperative period. We suggest that pituitary apoplexy should be included in the differential diagnosis of patients presenting with isolated third cranial nerve palsy with ptosis and that prompt neurosurgical decompression should be considered for the preservation of third cranial nerve function.

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Section: Discussionmentioning

confidence: 99%

Pituitary Apoplexy Presenting as Isolated Third Cranial Nerve Palsy with Ptosis : Two Case Reports

Cho

Joo

Kim

et al. 2009

J Korean Neurosurg Soc

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“…Fragmentation of atherosclerotic plaques with lodging of particles within the pituitary vasculature may potentiate gland infarction. 73 The association of pituitary tumor apoplexy with surgery, childbirth, and infection may reflect the greater activity of the pituitary gland in response to the increased need for stress hormones in these circumstances. 9 Additionally, estrogen therapy and pregnancy stimulate and enhance the demand on the pituitary.…”

Section: Precipitating Factors and Tumormentioning

confidence: 99%

Pituitary tumor apoplexy: characteristics, treatment, and outcomes

Verrees

Arafah²,

Selman

2004

FOC

184

152

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Pituitary tumor apoplexy is an uncommon event heralded by abrupt onset of severe headache, restriction of visual fields, deterioration of visual acuity, and weakness of ocular motility frequently coupled with clinical indications of decreased endocrine function. Hemorrhage into or necrosis of a preexisting sellar mass, usually a pituitary macroadenoma, produces an expansion of sellar contents. Compression of adjacent structures elicits the variable expression of symptoms referable to displacement of the optic nerves and chiasm and impingement of the third, fourth, and sixth cranial nerves. Damage to or destruction of the anterior pituitary leads to multiple acute and/or chronic hormone deficiencies in many patients. Medical management may be used in rare cases in which the signs and symptoms are mild and restricted to meningismus or ophthalmoplegia deemed to be stable. In patients with visual or oculomotor lability or an altered level of consciousness, expeditious surgical decompression, accomplished most commonly through a transsphenoidal approach, should be performed to save life and vision and to optimize the chance of regaining or maintaining pituitary function.

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“…A wide spectrum of situations has been described in association with pituitary apoplexy, some of which may represent pure coincidence. These associations include cardiac surgery, [25][26][27][28] anticoagulation, 6,29 angiography, 30,31 pneumoencephalography, 4,32 repetitive coughing secondary to respiratory infection, 16,30 closed head trauma, 3,33 estrogen therapy, 15 bromocriptine therapy, 29,34,35 radiotherapy, 36 diabetic ketoacidosis, 3 elevated intracranial pressure, 15,37 atheromatous emboli, 38 positive pressure mechanical ventilation, 27,39 chronic antiplatelet therapy, 40 triple bolus test [with insulin, thyrotropin-releasing hormone (TRH), and luteinizing hormone-releasing hormone (LHRH)], 41 gonadotropin-releasing hormone (GnRH) testing, 42 leuprolide administration for prostate cancer, 43,44 dissection of the internal carotid artery, 45 rupture of an intracavernous carotid artery aneurysm, 46 pituitary abscess, 47 and laparoscopic lumbar fusion. 48 Several interesting theories have been proposed about the roles of ischemia and hemorrhage in the pathogenesis of pituitary apoplexy.…”

Section: Clinical Presentationmentioning

confidence: 99%

“…48 Several interesting theories have been proposed about the roles of ischemia and hemorrhage in the pathogenesis of pituitary apoplexy. 4,6,7,38 Bailey 1 proposed that endarteritis of the pituitary gland was the source of hemorrhage. Brougham and coworkers 3 believed that large pituitary tumors outgrew their blood supply and developed areas of ischemic necrosis and subsequent hemorrhage.…”

Section: Clinical Presentationmentioning

confidence: 99%

Pituitary Apoplexy

Liu¹,

Rovit²,

Couldwell³

2002

Seminars in Neurosurgery

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Pituitary apoplexy is an uncommon complication of pituitary adenomas. The syndrome is manifest by an abrupt onset of signs and symptoms associated with infarction or hemorrhage into a preexisting pituitary adenoma. The lesion swells and expands, leading to compression of local suprasellar and parasellar structures. The incidence of pituitary apoplexy ranges from 1 to 20% in surgically verified pituitary adenomas, with a slight male predominance. Most frequently, pituitary apoplexy occurs in previously undiagnosed pituitary adenomas. The diagnosis may often be confused with aneurysmal subarachnoid hemorrhage or meningitis. When pituitary apoplexy is misdiagnosed and left untreated, the neurological sequelae can be devastating, resulting in permanent blindness, coma, or death. Glucocorticoid administration and transsphenoidal decompression remain the mainstay of treatment in this acute event.Objectives: Upon completion of this article, the reader should be able to identify the clinical manifestations of pituitary apoplexy, be familiar with the mechanisms of pathogenesis, and understand the importance of rapid diagnosis and treatment of pituitary apoplexy.

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Pituitary Apoplexy: The Role of Atheromatous Emboli

Cited by 30 publications

References 21 publications

Pituitary Apoplexy Presenting as Isolated Third Cranial Nerve Palsy with Ptosis : Two Case Reports

Pituitary Apoplexy Presenting as Isolated Third Cranial Nerve Palsy with Ptosis : Two Case Reports

Pituitary tumor apoplexy: characteristics, treatment, and outcomes

Pituitary Apoplexy

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