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William T Couldwell - One of the best experts on this subject based on the ideXlab platform.
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Apoplexy in pituitary microadenomas.
Acta Neurochirurgica, 2010Co-Authors: Benjamin R. Randall, William T CouldwellAbstract:Pituitary Apoplexy is a clinical syndrome of hemorrhage or infarction of a pituitary adenoma. It has classically been associated with pituitary macroadenomas. The authors report three cases of pituitary Apoplexy that occurred in patients with pituitary microadenomas. The presentation, endocrine results, and radiological and clinical outcome of each patient are described. In each of these cases of pituitary Apoplexy due to microadenoma, the presenting headache was mistakenly attributed to a different diagnosis. The authors propose that pituitary Apoplexy associated with a microadenoma may be much more common than appreciated and could be misdiagnosed as headache of alternative cause. Clinicians and radiologists should be aware of this clinical presentation.
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hemorrhagic and nonhemorrhagic rathke cleft cysts mimicking pituitary Apoplexy
Journal of Neurosurgery, 2008Co-Authors: Mandy J Binning, James K Liu, John Gannon, Anne G Osborn, William T CouldwellAbstract:Object Rathke cleft cysts (RCCs) are infrequently symptomatic, and Apoplexy is one of the most unusual presentations. Only a few cases of Apoplexy associated with RCCs have been reported, and their clinical, imaging, surgical, and pathological features are poorly understood. In the cases that have been reported, intracystic hemorrhage has been a consistent finding. The authors report 6 cases of RCCs in which the presenting clinical and imaging features indicated pituitary Apoplexy, both with and without intracystic hemorrhage. Methods The authors retrospectively reviewed charts and magnetic resonance (MR) imaging studies obtained in patients who underwent transsphenoidal surgery for RCC. Six patients were identified who presented with symptoms and MR imaging characteristics consistent with pituitary Apoplexy but were found intraoperatively to have an RCC. All 6 patients presented with a sudden headache, 2 with visual loss, and 1 with diplopia. Review of the preoperative MR images demonstrated mixed signal...
Stan Van Uum - One of the best experts on this subject based on the ideXlab platform.
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remission of acromegaly after pituitary Apoplexy case report and review of literature
Endocrine Practice, 2009Co-Authors: Lisaann Fraser, Donald H Lee, Paul Cooper, Stan Van UumAbstract:Objective: To identify and present cases of acromegaly in which pituitary Apoplexy resulted in remission of acromegaly, with normalization of insulinlike growth factor-I and growth hormone levels. Methods: We present a case history of a personal patient and review the related literature in PubMed and Ovid MEDLINE. Results: A 34-year-old man with classic acromegaly had spontaneous pituitary Apoplexy, resulting in remission of his acromegaly and diabetes. Moreover, we identified 21 other similar cases in the literature and analyze the clinical presentations, possible Apoplexy triggers, and hormonal sequelae. All these patients were "cured" of acromegaly, and 68% of them experienced other pituitary hormone insufficiencies after pituitary Apoplexy, including 2 cases of panhypopituitarism. Conclusion: Pituitary Apoplexy can result in remission of acromegaly and in partial or complete anterior or posterior (or both) pituitary insufficiency. Thus, after suspected or confirmed pituitary Apoplexy, pituitary hormone secretion must be reevaluated. This assessment may result in initiation of appropriate substitution therapy, a change in management of growth hormone overproduction, or both interventions.
Peter Laurberg - One of the best experts on this subject based on the ideXlab platform.
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frequent occurrence of pituitary Apoplexy in patients with non functioning pituitary adenoma
Clinical Endocrinology, 2006Co-Authors: Husted E Nielsen, Jorgen Lindholm, P Bjerre, Sandahl J Christiansen, Claus Hagen, Svend Juul, J O L Jorgensen, Anders Kruse, Peter LaurbergAbstract:Background and objective There is agreement in the literature that pituitary Apoplexy is a rare disorder. As our experience differs from this view, we analysed the incidence in patients operated on for a nonfunctioning pituitary adenoma. Patients and design One hundred ninety-two consecutive patients with a suprasellar, clinically inactive adenoma operated on during the period 1985-1996 were retrospectively reviewed. A diagnosis of pituitary Apoplexy was made from relevant neurological symptoms together with pertinent findings at operation. Results Pituitary Apoplexy occurred in 41 patients (21%), in 23 patients within 12 days prior to the operation. The male/female ratio was 1-9. Median follow-up time was 13-7 years (range 8-9-19-9). During this period, 12 patients had died, yielding a standard mortality ratio of 1-09 (95% CI 0.62-1.92), similar to that in the patients who had not sustained pituitary Apoplexy. Postoperatively, 24% of the patients had normal pituitary function, 38% were panhypopituitary and partial pituitary insufficiency was present in 38%. Subnormal GH secretion was present in virtually all patients tested. Two patients died within 60 days of surgery and in two no or incomplete data were available, although they most likely were panhypopituitary. Conclusion Most of our findings add little to what is known about pituitary Apoplexy. On one point, however, they are contrary to previously presented data. We found a much higher incidence of pituitary Apoplexy despite rather rigorous criteria for the diagnosis. The outcome as regards survival and endocrine function was not different from that in patients with a nonfunctioning adenoma who did not suffer pituitary Apoplexy.
Mandy J Binning - One of the best experts on this subject based on the ideXlab platform.
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hemorrhagic and nonhemorrhagic rathke cleft cysts mimicking pituitary Apoplexy
Journal of Neurosurgery, 2008Co-Authors: Mandy J Binning, James K Liu, John Gannon, Anne G Osborn, William T CouldwellAbstract:Object Rathke cleft cysts (RCCs) are infrequently symptomatic, and Apoplexy is one of the most unusual presentations. Only a few cases of Apoplexy associated with RCCs have been reported, and their clinical, imaging, surgical, and pathological features are poorly understood. In the cases that have been reported, intracystic hemorrhage has been a consistent finding. The authors report 6 cases of RCCs in which the presenting clinical and imaging features indicated pituitary Apoplexy, both with and without intracystic hemorrhage. Methods The authors retrospectively reviewed charts and magnetic resonance (MR) imaging studies obtained in patients who underwent transsphenoidal surgery for RCC. Six patients were identified who presented with symptoms and MR imaging characteristics consistent with pituitary Apoplexy but were found intraoperatively to have an RCC. All 6 patients presented with a sudden headache, 2 with visual loss, and 1 with diplopia. Review of the preoperative MR images demonstrated mixed signal...
Griffith R. Harsh - One of the best experts on this subject based on the ideXlab platform.
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pituitary Apoplexy associated with carotid compression and a large ischemic penumbra
World Neurosurgery, 2016Co-Authors: Eric S Sussman, Arjun V Pendharkar, Achal S Achrol, Griffith R. HarshAbstract:Background Pituitary Apoplexy is an acute clinical syndrome caused by pituitary gland hemorrhage or infarction. Rarely, this clinical syndrome is associated with cerebral infarction secondary to compression of an internal carotid artery. We report an unusual case of pituitary Apoplexy associated with a cerebral infarct with a large ischemic penumbra. Case Description The patient presented with headaches and visual disturbance and was found to have pituitary Apoplexy. Findings of his neurologic examination showed he had rapidly deteriorated, with obtundation, ophthalmoplegia, and left hemiplegia. Computed tomography perfusion images revealed a right hemispheric infarct with a large ischemic penumbra. Emergent decompressive transsphenoidal resection was performed. The patient had dramatic neurologic recovery, and postoperative imaging revealed salvage of most of the previously identified penumbra. Conclusions Cerebral perfusion imaging is a useful diagnostic tool for identifying the subset of pituitary Apoplexy patients that may benefit from emergent surgical intervention.
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pituitary Apoplexy after leuprolide injection for ovum donation
Journal of Adolescent Health, 2003Co-Authors: Gregory Engel, Michelle Huston, Carter E Beck, Sachie Oshima, Griffith R. Harsh, Myer H Rosenthal, Carlos A CamargoAbstract:Abstract Abstract Patients with occult pituitary adenomas infrequently present with pituitary Apoplexy. Precipitation of pituitary Apoplexy by gonadotropin releasing hormone or gonadotropin releasing hormone agonists has been described. The pathophysiologic mechanism by which these agents induce Apoplexy remains unclear. We describe a case of pituitary Apoplexy in a young woman receiving leuprolide in preparation for ovum donation. Severe hyponatremia, cerebral vasospasm and infarction, and diabetes insipidus complicated this patient's prolonged hospital course. To our knowledge, pituitary Apoplexy after gonadotropin releasing hormone agonist use for ovum donation has not been previously described. The use of leuprolide or other gonadotropin releasing hormone agonists for pituitary down-regulation in conjunction with ovarian stimulation can have serious consequences in women harboring unrecognized pituitary adenomas. Thorough endocrine screening should be performed prior to initiating therapy.
