Symptoms Of Pituitary Apoplexy Research Articles

Patient diagnosed with acromegaly and pituitary apoplexy after breast carcinoma treatment: challenges in diagnosis and management

The clinical case presented describes a 44-year-old woman with a history of mucinous carcinoma in the right breast, who is diagnosed with a pituitary adenoma. Physical examination revealed signs of acromegaly, such as macroglossia and palmar hyperhidrosis. Hormonal tests were performed and showed elevated levels of insulin-like growth factor type 1 (IGF-1). The patient received GnRH analogues for breast cancer; and started medical treatment with somatostatin analogues for acromegaly, which provided improvement in symptoms. Pituitary bleeding was detected during hormone treatment, which caused the growth of the adenoma, causing it to contact the optic chiasm, although no symptoms of pituitary apoplexy were present. Transsphenoidal endoscopic surgery was performed to remove the adenoma, and the diagnosis of pituitary adenoma was confirmed by pathology. The importance of the evaluation of comorbidities in patients with acromegaly is discussed. Pituitary apoplexy as an uncommon complication of pituitary adenomas, which may be associated with the use of GnRH analogues, is addressed. Pre-surgical medical treatment in acromegaly is also discussed, highlighting the importance of a comprehensive assessment of prognostic factors and appropriate treatment selection to improve clinical outcomes. In conclusion, the importance of a multidisciplinary and personalized approach in the management of patients with GH-producing pituitary adenomas to improve quality of life and clinical outcomes is highlighted.

SAT-243 Lymphocytic Hypophysitis Mimicking Pituitary Apoplexy in a 27-Year-Old Woman

Introduction:Lymphocytic hypophysitis is an uncommon inflammatory disorder of the pituitary gland. Peripartum women are most often affected, but it can be seen in a wide range of patients. Patients can present with pituitary dysfunction or mass effect symptoms, making it difficult to differentiate from a pituitary adenoma. Pituitary apoplexy is an acute syndrome due to hemorrhage into the pituitary gland causing headache, visual deficits, and hypoadrenalism. We present a case of a woman with a pituitary mass presenting with symptoms mimicking pituitary apoplexy, in whom surgical pathology later revealed lymphocytic hypophysitis without evidence of hemorrhage.Clinical Case:A 27-year-old non-pregnant female presented with severe headaches, nausea, vomiting, and diplopia for four days. A presumed pituitary macroadenoma was diagnosed two years previously during a workup for irregular menses. An emergency evaluation with a CT angiogram of the head showed enhancement at the superior aspect of and surrounding the pituitary gland. MRI of the pituitary revealed an enhancing 17 x 17 mm sellar and suprasellar mass compressing the optic chiasm, without evidence of the normal pituitary posterior bright spot. Visual field testing was normal. She was referred for transsphenoidal resection of the pituitary mass due to persistent headaches, optic chiasm impingement, and suspicion of pituitary apoplexy. Intraoperatively, there was no evidence of hemorrhage. Central diabetes insipidus and hypothyroidism developed in the post-operative period. She was discharged on hydrocortisone replacement therapy (20 mg in the morning, 10 mg in the afternoon). An outpatient random cortisol level of 1.2 mcg/dL (reference: 6.7 - 22.6 mcg/dL) while off hydrocortisone for twenty-four hours confirmed hypocortisolism. Surgical pathology showed moderate lymphocytic infiltrate and focal germinal centers in the adenohypophysis consistent with lymphocytic hypophysitis.Conclusion:Although lymphocytic hypophysitis is well-described in the literature, its association with symptoms suggesting pituitary apoplexy has been reported only rarely. This atypical case shows that lymphocytic hypophysitis can present with acute symptoms mimicking pituitary apoplexy. The case highlights the difficulties in recognizing lymphocytic hypophysitis prior to surgery and emphasizes the need to consider the diagnosis in patients presenting with pituitary masses and/or symptoms of pituitary apoplexy.

Spontaneous regression of nonfunctioning pituitary macroadenoma: A case report

Abstract A case involving a 13-year-old girl with nonfunctioning pituitary macroadenoma is discussed. The patient visited the hospital for checkup after experiencing a head injury secondary to syncope. A computed tomography (CT) scan revealed a pituitary mass with mildly higher density. Magnetic resonance imaging (MRI) with contrast enhancement showed that the mass contained a hyperintense area and it elevated the optic chiasm. The patient had blurred vision in her right eye. No endocrinological abnormalities were found. When the patient was admitted for surgical removal of the mass 1 month later, her visual acuity had improved. A repeat MRI showed that the size of the pituitary mass had dramatically reduced. During the following 2 years, the mass showed further reduction in size and did not re-grow. Since symptoms of pituitary apoplexy were not observed, we believe that asymptomatic apoplexy occurring at the time of the first visit may have caused regression of the tumor.

Pituitary Apoplexy Presenting Atypical Time Course of Ophthalmic Symptoms

Pituitary apoplexy is defined as a sudden loss of blood supply to the pituitary gland, leading to tissue necrosis and hemorrhage. Its clinical symptoms are characterized by sudden onset of headache, nausea, vomiting, ophthalmic symptoms and hormonal dysfunction. A 65-year-old woman presented with left-sided ptosis and blurred vision. These ophthalmic symptoms gradually worsened for one month without headache, visual acuity and field deficit. Neuro-ophthalmic examination revealed left oculomotor nerve palsy. Magnetic resonance imaging (MRI) revealed a round mass lesion in the left cavernous sinus, which was initially suspected as thrombosed cerebral aneurysm or hemorrhagic Rathke's cleft cyst. The mass lesion was finally diagnosed as pituitary apoplexy. The patient underwent trans-sphenoidal surgery and oculomotor nerve palsy improved after the surgery. Early diagnosis and treatment including surgical decompression are crucially important in patients with oculomotor nerve palsy in pituitary apoplexy, but the symptoms of pituitary apoplexy may slowly progress. It should be noted that pituitary apoplexy could be misdiagnosed as cerebral aneurysm or Rathke's cleft cyst.

Hypothalamic Lymphoma with Symptoms Mimicking Pituitary Apoplexy

A 30-year-old healthy woman presented with 2 days of severe headaches, fever, dizziness and then worsening vision rapidly developed. She was found to have polydipsia and polyuria with signs of dehydration. The clinical features of this patient were suggestive of pituitary apoplexy. CT-scan and brain MR-imaging showed a 36-mm hypothalamic mass with suprasellar extension and optic chiasm infiltration (Pictures 1, 2). Hormonal profiles revealed low levels of cortisol and thyroxine with a hyperprolactinemia. Hormonal substitution was administered. A CT-scan stereotactic biopsy was performed. Pathologic examination revealed a malignant large B cell lymphoma (CD20+). Staging work-up showed no evidence of tumor elsewhere in the body. HIV-test was negative. The patient was transferred to the department of hematology for further evaluation and chemotherapy. Unfortunately, she refused any adjuvant treatment and returned to her home. She died two months later. Few cases of primary hypothalamic lymphoma have been previously reported; the present case was the first one presenting with symptoms of pituitary apoplexy (1, 2). Hypothalamic lymphoma is not a simple clinical curiosity but a potentially life-threatening pathology regarding their metabolic complications.

What Is the Natural History of Nonoperated Nonfunctioning Pituitary Adenomas?

Limited information is available on the outcome of clinically nonfunctioning pituitary adenomas (NFAs) in patients who are not operated upon and do not receive radiotherapy for protracted periods. Most reports are of selected cases of incidentally found lesions. Most NFAs escape early detection and are recognized only when large enough to exert pressure on surrounding tissues. This retrospective study was based on 40 patients presenting in the years 1989-2005, 16 with microadenomas and 24 with macroadenomas. All patients had imaging features suggesting pituitary adenoma but no clinical or biochemical evidence of hormonal hypersecretion. Follow-up averaged 42 months. Half of the macroadenomas and 12.5% of microadenomas became larger during follow-up. The 48-month probabilities of tumor enlargement were 44% and 19%, respectively. Of patients whose tumors enlarged, 57% had new or more advanced visual field defects; all of them had macroadenomas. The optic chiasm was involved in 21% of patients, all of whom also had macroadenomas. None of these patients had deteriorating vision. Two-thirds of macroadenomas that increased in size were accompanied by new or worsening visual field defects. In contrast, none of the microadenomas enlarged enough to compromise vision. Neither gender nor age at presentation predicted enlargement of either microadenomas or macroadenomas. In patients with macroadenomas, enlargement was not predicted by the presence of a visual field defect or cavernous sinus invasion at the time of presentation. No patient had symptoms of pituitary apoplexy. The investigators conclude that a policy of watchful waiting is reasonable for patients having nonfunctioning pituitary microadenomas, but probably is not safe for those with macro-NFAs.

Two Rare Cases of Pituitary Metastases from Breast and Kidney Cancers

Pituitary metastases, though very uncommon, may cause endocrine and neurosurgical problems. The clinical manifestation of such metastases is highly variable. Most of the metastatic pituitary tumours are oligosymptomatic. We report two cases of metastatic pituitary lesions. The first patient, a 52-year old female, with metastatic breast cancer, developed symptomatic anterior pituitary insufficiency. The second patient, a 46-years old female presented with signs and symptoms of pituitary apoplexy and visual impairment due to metastasis from renal cancer. None of them was diagnosed with diabetes insipidus, the most common manifestation related to pituitary metastatic mass.

Two Cases of Acromegaly with Empty Sella

An empty sella may develop as a consequence of a primary congenital weakness of the diaphragm for which no secondary cause is evident. A secondary empty sella may develop after infarction of a pituitary adenoma or because of surgical or radiation-induced damage to the sellar diaphragm. Acromegaly is caused by growth hormone (GH) hypersecretion and the resultant elevated levels of circulating insulin like growth factor-1. The underlying abnormality in more than 98% of cases is hypersecretion of GH by a pituitary GH-producing tumor. Necrosis and hemorrhage, which frequently occur in pituitary adenomas, may lead to complete or partial disappearance of the adenoma, and subsequently, to an empty sella. We report two cases of acromegaly with empty sella, and the patients had no symptoms of pituitary apoplexy. (J Kor Endocrinol Soc 21:572~576, 2006)