Pressure and blood flow in pituitary adenomas measured during transsphenoidal surgery

Kruse, Andreas; Astrup, Jens; Cold, Georg E.; Hansen, Henning Otte

doi:10.3109/02688699209023792

Cited by 44 publications

(29 citation statements)

References 29 publications

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“…15) Normal ISP is not known, but is believed to be similar to or less than the normal intracranial pressure of 7-15 mmHg. 6) The sharp increase in ISP leads to disturbance of anterior pituitary cell viability, which could increase the risk of ischemic necrosis and limit the potential for recovery of pituitary function. In our patient, MR imaging showed focal high intensity around the cavernous portion of the internal carotid artery, suggesting hemorrhagic infarction and not massive bleeding.…”

Section: Discussionmentioning

confidence: 99%

Pituitary Apoplexy Causing Internal Carotid Artery Occlusion -Case Report-

Chokyu

Tsuyuguchi

Goto

et al. 2011

Neurol. Med. Chir.(Tokyo)

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A 50-year-old man presented with pituitary apoplexy resulting in internal carotid artery occlusion manifesting as sudden onset of severe headache, right ptosis, and left hemiparesis, associated with visual impairment. Computed tomography showed a nodular mass, located in the sellar and suprasellar regions with early signs of acute cerebral ischemia. Magnetic resonance (MR) imaging indicated that the mass compressed the bilateral cavernous sinuses, resulting in obliteration of the cavernous portion of the right internal carotid artery. Right middle cerebral artery territory infarction was also found. Conservative therapy with steroids was given in the acute stage and repeated MR imaging showed recanalization of the internal carotid artery with reduction of the tumor size. The tumor was removed through the transsphenoidal approach to obtain a definitive diagnosis in the chronic stage. The histological diagnosis was consistent with non-functioning pituitary adenoma. Eye movement of this patient showed full recovery after the operation. Pituitary apoplexy resulting in internal carotid artery occlusion is rare. Surgical decompression through the transsphenoidal approach is appropriate, but the optimal timing should consider severe disturbance of visual acuity and visual field in the acute stage.

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Section: Discussionmentioning

confidence: 99%

Pituitary Apoplexy Causing Internal Carotid Artery Occlusion -Case Report-

Chokyu

Tsuyuguchi

Goto

et al. 2011

Neurol. Med. Chir.(Tokyo)

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“…The headache and the hormonal disturbance are among the factors that contribute to worsen the quality of life in a large number of patients 6 . The relationship between increased ISP, visual changes and headache was object of studies in recent years 4,[7][8][9][10][11][12][13][14][15] , including in Brazil 16 . However, none of these evaluations used scales for assessing the quality of life and severity of headache in patients with pituitary adenomas.…”

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confidence: 99%

Mean intrasellar pressure, visual field, headache intensity and quality of life of patients with pituitary adenoma

Pereira-Neto

Borba

Mello

et al. 2010

Arq. Neuro-Psiquiatr.

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Intrasellar pressure (ISP) measurement technique has recently opened a new line of research in neuroendocrinology. The absolute and mean ISP values were investigated in 25 patients consecutively operated at the Brasilia University Hospital (DF). These data were correlated with serum prolactin levels, number of visual quadrant affected, tumor size, quality of life (measured through the SF-36 scale) and graded headache (measured through the HIT-6 scale). No correlation was observed. The p values were 0.887; 0.137; 0.892; 0.812 and 0.884; respectively. The HIT-6 values were inversely and moderately correlated with total RAND SF-36 and its mental and physical dimensions. Key words: pituitary adenoma, intrasellar pressure, headache.Pressão intra-selar média, campo visual, intensidade de cefaléia e qualidade de vida em portadores de adenoma hipofisário resumo A técnica da medida da pressão intra-selar (PIS) abriu, recentemente, uma nova linha de pesquisa em neuroendocrinologia. O objetivo deste estudo foi aferir os valores absolutos da PIS e calcular a pressão intra-selar média (PIM) em uma população de 25 pacientes operados consecutivamente no Hospital Universitário de Brasília (DF). Não se observou correlação significativa entre a PIM e o número de quadrantes visuais comprometidos (p=0,137), área do tumor (p=0,892), nível de qualidade de vida mensurado pela escala SF-36 (p=0,812) e a presença e a intensidade da cefaléia mensurada pela escala 884). Contudo, o HIT-6 correlacionou-se de forma inversa e intensidade moderada com os valores de HIT-6 e suas dimensões mental e física. Palavras-chave: adenoma hipofisário, pressão intraselar, cefaléia.Correspondence Paulo Andrade de Mello SMDB conjunto 7/casa 1

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“…1, [19][20][21] It has also been established in patients with pituitary apoplexy, 47 although it cannot be known if the increased pressure was a consequence of the apoplexy or the cause of it. Thus, the consistency of the pressure measurements and the nearly universal production of a histological pseudocapsule by the intratumoral pressure in small and large tumors, 27 increased pressure within the tumor that alters perfusion of it, and associated limited vascularity (see above) are baseline circumstances in all of these tumors.…”

Section: Discussionmentioning

confidence: 99%

“…19 Further, the development of a histological pseudocapsule, a result of the effect of increased pressure within an adenoma on the surrounding normal pituitary gland, begins to occur with tumors as small as 1-2 mm and occurs in essentially all microand macroadenomas. 27 This increased pressure within an adenoma, combined with intrinsically limited vascularity, reduces the perfusion of the tumor and enhances the susceptibility of it to ischemia and to infarction and occurs in large and small tumors (see below).…”

Section: 19-21mentioning

confidence: 99%

Apoplexy of pituitary adenomas: the perfect storm

Oldfield

Merrill

2015

JNS

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Pituitary tumors spontaneously infarct at a relatively high rate, higher than any other CNS tumor. This occurs with or without hemorrhage. The typical clinical entity was described relatively late, in 1950, by Brougham et al. 12 Since then pituitary apoplexy has been the subject of many reports describing the clinical presentation, patient management, imaging features, and outcome, as well as reports of acute circumstances predisposing to its occurrence. 9,10,14,15,17,[22][23][24][25]29,32,36,37,39,45 We propose here that infarction of these tumors is the product of a combination of intrinsic features of these tumors and that it is the tenuous imbalance between their high rate of demand for nutrients combined with their limited intrinsic blood supply that makes them vulnerable to infarction, with or without precipitating events, and suggest that this circumstance may permit new approaches to treatment based on this peculiar vulnerability. case of Pituitary apoplexyA 57-year-old male had the sudden onset of headache followed by excessive thirst, polydipsia, loss of energy, and abbreviatioNs FDG = fluorodeoxyglucose; PET = positron emission tomography; VEGF = vascular endothelial growth factor. submitted July 25, 2014. accePted October 8, 2014. iNclude wheN citiNg Published online April 10, 2015; DOI: 10.3171/2014.10.JNS141720. disclosure The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper. obJect Pituitary adenomas occasionally undergo infarction, apoplexy, which often destroys much of the tumor. It is well known that apoplexy can be precipitated by several acute factors, including cardiac surgery, other types of surgery, trauma, insulin infusion, and stimulation with administration of hypothalamic releasing factors. methods The prior focus on mechanisms underlying pituitary apoplexy has been on these acute events. Less attention has been given to the endogenous features of pituitary tumors that make them susceptible to spontaneous infarction, despite that most pituitary apoplexy occurs in the absence of a recognized precipitating event. The authors examine intrinsic features of pituitary adenomas that render them vulnerable to apoplexy-features such as high metabolic demand, paucity of angiogenesis, and sparse vascularity, qualities that have previously not been linked with apoplexy-and argue that it is these features of adenomas that underlie their susceptibility to spontaneous infarction. The sensitivity of freshly cultured pituitary adenomas to hypoglycemia is assessed. results Adenomas have high metabolic demand, limited angiogenesis, and reduced vessel density compared with the normal gland. Pituitary adenoma cells do not survive in the presence of reduced or absent concentrations of glucose. coNclusioNs The authors propose that the frequent ischemic infarction of pituitary adenomas is the product of intrinsic features of these tumors. These endogenous qualities create a tenuous balance between high metabolic demand and ...

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Pressure and blood flow in pituitary adenomas measured during transsphenoidal surgery

Cited by 44 publications

References 29 publications

Pituitary Apoplexy Causing Internal Carotid Artery Occlusion -Case Report-

Pituitary Apoplexy Causing Internal Carotid Artery Occlusion -Case Report-

Mean intrasellar pressure, visual field, headache intensity and quality of life of patients with pituitary adenoma

Apoplexy of pituitary adenomas: the perfect storm

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