Suspected Pituitary Apoplexy: Clinical Presentation, Diagnostic Imaging Findings and Outcome in 19 Dogs

Abstract

In human medicine, pituitary apoplexy (PA) is a clinical syndrome characterised by the sudden onset of neurological signs because of haemorrhage or infarction occurring within a normal or tumoral pituitary gland. The diagnosis is usually performed combining neurological signs and imaging findings. The aim of the present study is to describe the abnormal neurological signs, the diagnostic imaging findings, based on Computed Tomography (CT) and/or Magnetic Resonance Imaging (MRI), and the outcome in a population of dogs with suspected PA. Clinical cases were retrospectively reviewed. Nineteen cases of suspected PA were included. The majority of dogs showed behavioural abnormalities (11/19). Neurological signs more frequently identified were obtundation (7/19), vestibular signs (7/19) and epileptic seizures (6/19). The onset of neurological signs was per-acute in 14 out of 19 cases. Data regarding CT and MRI were available in 18 and 9 cases, respectively. Neurological signs resolved in less than 24 h in seven patients. The short-term prognosis was defined as favourable in the majority of our study population. The median survival time was of 7 months from the time of PA diagnosis. This is the first description of neurological signs, imaging findings and outcome in a large group of dogs with PA.

Adrenocorticotropic hormone-producing pituitary adenoma with pituitary apoplexy treated by surgical decompression: a case report

“…In recent years, cases of pituitary macroadenomas secondary to PTA have been reported in veterinary medicine; however, no effective treatment has been identified, and no case of surgical intervention with long-term prognostic follow-up has been reported [8,[10][11][12]. In the present case, T2*-weighted MRI on day 52 showed that the hemorrhage was concentrated in the dorsal portion of the pituitary tumor [22], and the ACTH concentration measured on day 51 was similar to that on day 9, suggesting that the ventral pituitary tissue maintained ACTH production.…”

“…Recently, a number of cases of PTA due to pituitarydependent hypercortisolism (PDH) caused by pituitary macroadenomas have been reported in dogs [10][11][12]. In eight of these cases, the dogs were euthanized due to severe seizures or death during computed tomography imaging [10][11][12].…”

“…Recently, a number of cases of PTA due to pituitarydependent hypercortisolism (PDH) caused by pituitary macroadenomas have been reported in dogs [10][11][12]. In eight of these cases, the dogs were euthanized due to severe seizures or death during computed tomography imaging [10][11][12]. In one case, trilostane medication was discontinued after the onset of PTA, and there was no recurrence of clinical signs during the 6-month follow-up period.…”

“…In one case, trilostane medication was discontinued after the onset of PTA, and there was no recurrence of clinical signs during the 6-month follow-up period. Another study, including 19 dogs with suspected PTA, reported a median survival time of 7 months (range: 0–102 months) from the time of PTA diagnosis [ 12 ]. However, to date, no reports on pituitary surgery in dogs after suspected PTA exist.…”

Presumed pituitary apoplexy in 26 dogs: Clinical findings, treatments, and outcomes

“…[12][13][14] A recent case series of 19 dogs (including 2 of the previously reported 6 dogs) described mainly altered mentation, vestibular dysfunction and seizures. 15 While computed tomography, histopathology, and postmortem findings are described in this literature, in addition to magnetic resonance imaging (MRI) findings of pituitary apoplexy in a cat, 16 published MRI findings in dogs with pituitary apoplexy appear to be limited to 8 cases. 14,15 Treatment options and outcome data are also limited in the veterinary literature, as many dogs are euthanized at the time of diagnosis or fail to survive to hospital discharge.…”