Pituitary enlargement in spontaneous intracranial hypotension—a diagnostic pitfall

Leung, Gilberto Ka Kit; Ho, Jenny; Pu, Jenny Kan-Suen

doi:10.1007/s00701-011-1099-x

Cited by 13 publications

(10 citation statements)

References 10 publications

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“…However, there are some pitfalls to avoid, such as the downward displacement of the cerebellar tonsils into the spinal canal, which may mimic a Chiari malformation (pseudo-Chiari malformation), subdural fluid collections mimicking a primary subdural hematoma, pachymeningeal enhancement that may be mistaken for an infectious or neoplastic disease, and pituitary hyperemia mimicking a pituitary tumor, such as an adenoma 8,11,12 .…”

Section: Discussionmentioning

confidence: 99%

Spontaneous intracranial hypotension and its complications

Girão

Sousa

Ribeiro

et al. 2018

Arq. Neuro-Psiquiatr.

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Spontaneous intracranial hypotension (SIH) is a syndrome that was unknown until the advent of magnetic resonance imaging (MRI). It is a cause of orthostatic headache, which remains underdiagnosed and, rarely, can result in several complications including dural venous sinus thrombosis, subdural hematoma and subarachnoid hemorrhage. Some of these complications are potentially life-threatening and should be recognized promptly, mainly by imaging studies. We reviewed the MRI of nine patients with SIH and describe the complications observed in three of these patients. Two of them had subdural hematoma and one had a dural venous sinus thrombosis detected by computed tomography and MRI. We concluded that MRI findings are of great importance in the diagnosis of SIH and its complications, which often influence the clinical-surgical treatment of the patient.

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Section: Discussionmentioning

confidence: 99%

Spontaneous intracranial hypotension and its complications

Girão

Sousa

Ribeiro

et al. 2018

Arq. Neuro-Psiquiatr.

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“…Furthermore, there are reports of cases with IH in which small liquid collections in the gland [ 18 ] and pituitary haemorrhages were observed, which was first described in an enlarged pituitary gland in 2011 by Spero et al Haemorrhage is likely caused by rupture of venous vessels, and it may be dangerous by causing certain hormonal disorders [ 3 , 19 ].…”

Section: Diagnostic Imagingmentioning

confidence: 99%

“…Cases of surgical resection of enlarged pituitary glands in IH due to misdiagnosis of macroadenoma have been reported [ 19 , 26 ].…”

Section: Differential Diagnosismentioning

confidence: 99%

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Diagnostic Imaging and Clinical Features of Intracranial Hypotension – Review of Literature

Michali-Stolarska¹,

Bladowska²,

Stolarski³

et al. 2018

Pol J Radiol

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SummaryIntracranial hypotension (IH) is an uncommon, benign, and usually self-limiting condition caused by low cerebrospinal fluid (CSF) pressure, usually due to CSF leakage. The dominant clinical finding is an orthostatic headache. Other common clinical features include fever, nausea, vomiting, and tinnitus.Magnetic resonance imaging (MRI) plays an important role in the diagnosis and follow-up of patients with IH. Specific MRI findings include intracranial pachymeningeal enhancement, sagging of the brain, pituitary enlargement, and subdural fluid collections.Intracranial hypotension can mimic other conditions such as aseptic meningitis or pituitary adenomas. Differential diagnosis is important, because misdiagnosis may lead to unnecessary procedures and prolonged morbidity.

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“…2,9,11,13,18 Moreover, sagging of the brain often is associated with distortion of the pituitary stalk. However, a systematic evaluation of pituitary function has not been reported in patients with spontaneous intracranial hypotension.…”

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confidence: 99%

Hyperprolactinemia due to spontaneous intracranial hypotension

Schievink¹,

Nuño²,

Rozen

et al. 2015

JNS

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SpontaneouS intracranial hypotension is an important cause of new, daily, persistent headaches that usually afflicts young to middle-aged adults, with a female predominance and a peak incidence in the 5th decade of life. 16 The headache is typically orthostatic and is often accompanied by nausea, neck pain, and hearing abnormalities. Spontaneous intracranial hypotension is uncommon, with an estimated incidence of approximately 5 per 100,000 per year. The cause of spontaneous intracranial hypotension is almost always a spontaneous spinal CSF leak, and a systemic connective tissue disorder affecting the spinal dura mater is often suspected.14 In spontaneous intracranial hypotension, pituitary enlargement is one of the 5 main imaging features that can be found on brain MRI (Sagging of the brain, Enhancement of the pachymeninges, Engorgement of venous structures, Pituitary enlargement, and Subdural fluid collections [SEEPS]). 16Pituitary enlargement in spontaneous intracranial hypotension has now been well documented and can resemble a pituitary tumor. 2,9,11,13,18 Moreover, sagging of the brain often is associated with distortion of the pituitary stalk. However, a systematic evaluation of pituitary function has not been reported in patients with spontaneous intracranial hypotension. Therefore, we investigated pituitary hormones in patients with this disorder. OBJect Spontaneous intracranial hypotension is an increasingly recognized cause of headaches. Pituitary enlargement and brain sagging are common findings on MRI in patients with this disorder. The authors therefore investigated pituitary function in patients with spontaneous intracranial hypotension. MethODS Pituitary hormones were measured in a group of 42 consecutive patients with spontaneous intracranial hypotension. For patients with hyperprolactinemia, prolactin levels also were measured following treatment. Magnetic resonance imaging was performed prior to and following treatment. reSultS The study group consisted of 27 women and 15 men with a mean age at onset of symptoms of 52.2 ± 10.7 years (mean ± SD; range 17-72 years). Hyperprolactinemia was detected in 10 patients (24%), ranging from 16 ng/ml to 96.6 ng/ml in men (normal range 3-14.7 ng/ml) and from 31.3 ng/ml to 102.5 ng/ml in women (normal range 3.8-23.2 ng/ml). In a multivariate analysis, only brain sagging on MRI was associated with hyperprolactinemia. Brain sagging was present in 60% of patients with hyperprolactinemia and in 19% of patients with normal prolactin levels (p = 0.02). Following successful treatment of the spontaneous intracranial hypotension, hyperprolactinemia resolved, along with normalization of brain MRI findings in all 10 patients. cONcluSiONS Spontaneous intracranial hypotension is a previously undescribed cause of hyperprolactinemia. Brain sagging causing distortion of the pituitary stalk (stalk effect) may be responsible for the hyperprolactinemia. Methods

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Pituitary enlargement in spontaneous intracranial hypotension—a diagnostic pitfall

Cited by 13 publications

References 10 publications

Spontaneous intracranial hypotension and its complications

Spontaneous intracranial hypotension and its complications

Diagnostic Imaging and Clinical Features of Intracranial Hypotension – Review of Literature

Hyperprolactinemia due to spontaneous intracranial hypotension

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