Repeated Remissions of Cushing's Disease Due to Recurrent Infarctions of an ACTH-Producing Pituitary Macroadenoma

Alarifi, Abdullah; Al-Zahrani, Ali; Salam, Suzan Abdel; Ahmed, Mohammed; Kanaan, Imaduddin

doi:10.1007/s11102-005-2961-8

Cited by 21 publications

(15 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…According to these results, confirmative diagnosis of pituitary apoplexy due to partial infarction of ACTH-secreting pituitary macroadenoma could were made. Similar reports of pituitary apoplexy caused by tumor infarction in a Cushing's disease have been mentioned, however their incidences were extremely rare 1) . Clinical manifestations of pituitary apoplexy are very diverse.…”

supporting

confidence: 66%

Pituitary Apoplexy due to Pituitary Adenoma Infarction

Kim

Park

Kim

et al. 2008

J Korean Neurosurg Soc

View full text Add to dashboard Cite

Pituitary apoplexy is a life-threatening clinical syndrome which is caused by the fulminant expansion of pituitary mass due to hemorrhage, hemorrhagic infarction or infarction of pituitary adenoma or the adjacent tissues of pituitary gland. Since first introduced by Bailey in 1898, the incidence of pituitary apoplexy varies from 0.6% to 22.8% 7,11,12,17) . However, pituitary apoplexy due to tumor infarction is very rare. We report two cases of pituitary apoplexies, caused by pituitary tumor infarction after surgery by transsphenoidal approach (TSA) for pituitary macroadenomas. These cases showed pathologic findings of tumor infarction without any signs of related hemorrhage or hemorrhagic infarction. CASE REPORT Case 1A 44-year-old male patient was admitted via emergency room due to sudden onset of severe headache, nausea, vomiting and visual disturbance. These symptoms were developed 5 days prior to admission. He had no specific previous medical history. Subarachnoid hemorrhage (SAH) was ruled out on brain computed tomography (CT), however sella magnetic resonance imaging (MRI) showed a mass lesion in the sella and suprasellar area which was measured about 3.1×2.3×2.2 cm. On T1 weighted images, there was hyperintense peripheral portion and an isointense central portion. With gadolinium (Gd) enhancement, the mass showed peripheral rim enhancement but there was no enhancement in the hypointense central portion (Fig. 1). Diffusion MR images were not obtained due to emergency operation. The optic chiasm was compressed by the mass which resulted in bitemporal hemianopsia and the worsening of the visual acuity of the right eye to 0.4 and maintaining that of the left, 1.1. There was a decrease in the levels of free T4 (4 µg/dl), TSH (0.28 µU) and cortisol (2 µg/dl). Steroid was administered before the operation. The mass was totally resected by TSA and there was no evidence of remaining enhancing tumor or hemorrhage seen in the postoperative first day follow-up sella MRI (Fig. 2). Microscopic examination of the resected mass showed total infarction without viable tumor cells (Fig. 2). The cells showed pale appearance and maintained cellular architecture. These findings led to the diagnosis of pituitary apoplexy due to total tumor infarction of a nonfunctioning pituitary macroadenoma. Clinical symptoms and

show abstract

supporting

confidence: 66%

Pituitary Apoplexy due to Pituitary Adenoma Infarction

Kim

Park

Kim

et al. 2008

J Korean Neurosurg Soc

View full text Add to dashboard Cite

show abstract

“…5,6 Spontaneous resolution of HAC due to infarction of ACTH-secreting pituitary adenoma has been reported in human apoplexy. 20,21 There is no predominant tumor type in pituitary tumor apoplexy in humans. Expansion of the pituitary gland is limited by the relatively unyielding surrounding structures of the pituitary fossa.…”

Section: Discussionmentioning

confidence: 99%

Pituitary Apoplexy-Like Disease in 4 Dogs

Bertolini¹,

Rossetti²,

Caldín³

2007

J Vet Int Med

View full text Add to dashboard Cite

“…Cases of spontaneous biochemical remission after PA have been reported for GH-secreting (120,121,122), ACTH-secreting (18,123,124) and prolactin-secreting (122) tumours. However, in a large case series, 90% of the functioning tumours remained active following PA, the majority of which required surgery (19).…”

Section: European Journal Of Endocrinologymentioning

confidence: 99%

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

Căpățînă

Inder

Karavitaki

et al. 2015

European Journal of Endocrinology

128

View full text Add to dashboard Cite

Pituitary tumour apoplexy (PA) is a rare clinical syndrome that occurs as a result of acute haemorrhage and/or infarction within a frequently undiagnosed pituitary tumour. The sudden enlargement of the pituitary mass undergoing PA is responsible for a wide range of acute symptoms/signs (severe headache, visual loss, diplopia, hypopituitarism, impaired consciousness) which, together with the radiological evidence of a pituitary lesion, establish the diagnosis. The optimal care of PA requires involvement of a multidisciplinary team including endocrinologist, neurosurgeon, neuroophthalmologist and the management strategy that depends on the clinical manifestations, as well as the presence of co-morbidities. Prompt surgical decompression is initially indicated in cases with severe or progressive impairment of the visual acuity or the visual fields or with altered mental state and leads to visual and neurological recovery in most of the patients. The patients with mild, stable clinical picture (including those with isolated ocular palsies) can be managed conservatively (support of fluid and electrolyte balance and stress doses of steroids in most cases) with favourable visual and neurological outcome. Frequent reassessment is mandatory because the clinical course can be unpredictable; if progression of symptoms occurs, later elective surgery is indicated and is beneficial, especially in terms of visual outcome. The endocrinological outcome is less favourable, irrespective of the treatment option, with many patients remaining on long-term replacement therapy. Despite the above guidelines, clear proof of optimal outcomes in the form of randomised controlled trials is lacking. Regrowth of the pituitary tumour years after a PA episode is possible and patients require long-term surveillance.

show abstract

Repeated Remissions of Cushing's Disease Due to Recurrent Infarctions of an ACTH-Producing Pituitary Macroadenoma

Cited by 21 publications

References 31 publications

Pituitary Apoplexy due to Pituitary Adenoma Infarction

Pituitary Apoplexy due to Pituitary Adenoma Infarction

Pituitary Apoplexy-Like Disease in 4 Dogs

MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

Contact Info

Product

Resources

About