Sparsely Granulated Corticotroph Pituitary Macroadenoma Presenting With Pituitary Apoplexy Resulting in Remission of Hypercortisolism

Liu, Tao; Rossiter, John P.; Houlden, Robyn L.; Awad, Sara M.

doi:10.1016/j.aace.2022.04.003

Cited by 4 publications

(4 citation statements)

References 20 publications

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“…Complete blindness was reported in two papers [ 199 , 212 ]. Visual field defects varied from (mostly common) hemianopia [ 33 , 39 , 55 , 80 , 126 , 135 , 179 , 187 , 197 ] to cranial nerve palsies manifesting as diplopia in the majority of these cases [ 32 , 34 , 35 , 49 , 50 , 58 , 63 , 66 , 68 , 75 , 84 , 85 , 91 , 92 , 114 , 115 , 117 , 127 , 130 , 142 , 147 , 150 , 157 , 163 , 164 , 186 , 191 , 194 , 195 , 207 , 214 ] followed by ptosis [ 34 , 35 , 50 , 59 , 75 , 77 , 79 ,…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

“…The most frequent cranial nerve affected was the oculomotor nerve, but rarely, patients also presented with abducens [ 25 , 44 , 77 , 81 , 84 , 85 , 91 , 98 , 113 , 120 , 121 , 123 , 124 , 128 , 142 , 168 , 174 , 182 , 192 , 207 ] and trochlear [ 25 , 63 , 81 , 84 , 102 , 121 , 123 , 124 , 149 , 168 , 182 , 209 ] nerves palsies. Optic chiasm compression was specified in 18 articles [ 32 , 33 , 46 , 55 , 62 , 63 , 65 , 69 , 80 , 123 , 125 , 169 , 177 , 185 , 186 , 191 , 192 , …”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

“…Endocrine features in subjects admitted for PA include PitNETs-associated hormonal excess, even though most patients were nonfunctioning tumors, respectively, tumor- or PA-caused hypopituitarism (as mentioned, we did not include patients with previously recognized and treated PitNETs). In terms of clinical presentation, Cushingoid features (corticotroph PitNET) are reported in 5 studies (less than 0.005% of the patients): two males of 30, respective 33 years [ 31 , 186 ], a cases series of 4 females aged between 26 and 45 years [ 33 ], and other two women of 35, respective 47 years [ 86 , 161 ]. Acromegaly (caused by somatotroph or lactosomatotroph PitNET) was recognized in 8 patients (0.005%) aged between 26 and 50 years; a male [ 86 , 109 , 136 , 148 , 156 , 217 ] to female [ 38 , 78 ] ratio of 6 to 2.…”

Section: Pitnet Complicated With Pamentioning

confidence: 99%

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Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

et al. 2023

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Various complications of pituitary neuroendocrine tumors (PitNET) are reported, and an intratumor hemorrhage or infarct underlying pituitary apoplexy (PA) represents an uncommon, yet potentially life-threatening, feature, and thus early recognition and prompt intervention are important. Our purpose is to overview PA from clinical presentation to management and outcome. This is a narrative review of the English-language, PubMed-based original articles from 2012 to 2022 concerning PA, with the exception of pregnancy- and COVID-19-associated PA, and non-spontaneous PA (prior specific therapy for PitNET). We identified 194 original papers including 1452 patients with PA (926 males, 525 females, and one transgender male; a male-to-female ratio of 1.76; mean age at PA diagnostic of 50.52 years, the youngest being 9, the oldest being 85). Clinical presentation included severe headache in the majority of cases (but some exceptions are registered, as well); neuro-ophthalmic panel with nausea and vomiting, meningism, and cerebral ischemia; respectively, decreased visual acuity to complete blindness in two cases; visual field defects: hemianopia, cranial nerve palsies manifesting as diplopia in the majority, followed by ptosis and ophthalmoplegia (most frequent cranial nerve affected was the oculomotor nerve, and, rarely, abducens and trochlear); proptosis (N = 2 cases). Risk factors are high blood pressure followed by diabetes mellitus as the main elements. Qualitative analysis also pointed out infections, trauma, hematologic conditions (thrombocytopenia, polycythemia), Takotsubo cardiomyopathy, and T3 thyrotoxicosis. Iatrogenic elements may be classified into three main categories: medication, diagnostic tests and techniques, and surgical procedures. The first group is dominated by anticoagulant and antiplatelet drugs; additionally, at a low level of statistical evidence, we mention androgen deprivation therapy for prostate cancer, chemotherapy, thyroxine therapy, oral contraceptives, and phosphodiesterase 5 inhibitors. The second category includes a dexamethasone suppression test, clomiphene use, combined endocrine stimulation tests, and a regadenoson myocardial perfusion scan. The third category involves major surgery, laparoscopic surgery, coronary artery bypass surgery, mitral valvuloplasty, endonasal surgery, and lumbar fusion surgery in a prone position. PA in PitNETs still represents a challenging condition requiring a multidisciplinary team from first presentation to short- and long-term management. Controversies involve the specific panel of risk factors and adequate protocols with concern to neurosurgical decisions and their timing versus conservative approach. The present decade-based analysis, to our knowledge the largest so far on published cases, confirms a lack of unanimous approach and criteria of intervention, a large panel of circumstantial events, and potential triggers with different levels of statistical significance, in addition to a heterogeneous clinical picture (if any, as seen in subacute PA) and a spectrum of evolution that varies from spontaneous remission and control of PitNET-associated hormonal excess to exitus. Awareness is mandatory. A total of 25 cohorts have been published so far with more than 10 PA cases/studies, whereas the largest cohorts enrolled around 100 patients. Further studies are necessary.

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Section: Pitnet Complicated With Pamentioning

confidence: 99%

Section: Pitnet Complicated With Pamentioning

confidence: 99%

Section: Pitnet Complicated With Pamentioning

confidence: 99%

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Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

et al. 2023

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“… 1 Another report illustrates a rare case of hypercortisolism remission due to apoplexy of sparsely granulated corticotroph tumor with subsequent central adrenal insufficiency, hypothyroidism, and hypogonadism. 2 Authors also described the diagnosis and management of adrenal crisis precipitated by COVID-19 messenger RNA vaccination in a patient with hypopituitarism. 3 Lastly, another case described a young boy with a β-human chorionic gonadotropin (hCG)-secreting intracranial germ cell tumors with elevated testosterone level and presented with rapidly progressive precocious puberty.…”

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confidence: 99%