Treatment Of Pituitary Apoplexy Research Articles

Letter to the Editor. Treatment for pituitary apoplexy.

Letter to the Editor. Treatment for pituitary apoplexy.

Outcome in pituitary apoplexy patients, stratified by delay between symptom appearance and surgery: A single center retrospective analysis

BackgroundThere are surgical and conservative management strategies in pituitary apoplexy patients. The use of both methods may lead to delayed surgery in the treatment of pituitary apoplexy. The aim of this study was to evaluate the surgical indications and outcomes of a series of patients with pituitary apoplexy according to delay between surgery and symptom onset. MethodsA retrospective analysis was performed of 2711 cases with sellar pathologies treated with endoscopic transsphenoidal surgery in a single centre. Inclusion criteria were histopathological confirmation of haemorrhage or necrosis, acute onset and at least one of the following: symptoms of endocrine dysfunction; visual impairment; ophtalmoplegia; headache; or altered consciousness. Patients were divided into three groups based on the number of days from initial symptoms to surgery: early (1–7 day), delayed (8–21 days) and late (>21 day). The indication for and outcome of surgery was reviewed according to symptoms and timing of surgery. ResultsNinety-one patients with pituitary apoplexy underwent surgery. The median time from ictus until surgery was 16 days (1–120 days). Headache was the most common presenting symptom. Visual impairment and ophtalmoplegia were found in 26.4% and 23.1% of patients, respectively. Surgical intervention was successful in treatment of headache in 82 (97,6%) patients. In patients in the early or delayed groups a significant improvement was found between pre- and post-operative headache, ocular palsy, visual impairment, and hormone deficiencies. Patients in the late group also had a significant improvement in headache and visual symptoms after surgery. ConclusionSurgery was sufficient in headache, endocrine, and neuro-ophthalmic outcomes at first 21 days (early and delayed groups). Beyond 21 days (late group), surgery was not effective on recovery of pituitary function.

Sudden Visual Impairment In Sellar Region Tumor: A Case Of Pituitary Apoplexy

Objective : Pituitary apoplexy described as an acute hemorrhagic infarction of the pituitary adenoma causing sudden increase of intra sellar pressure. This condition is a life-threatening disease. The purpose of this article is to report about clinical symptom and methods to diagnose pituitary apoplexy.
 Methods : A case presentation
 Result : A 40 y.o male came with a complain of blurry vision since 1 year. Two months before admission, he felt sudden worsening of his visual acuity. He went to private hospital and there was bleeding in his brain CT scan. His right eye visual acuity was 1/300 and his left best visual acuity was 6/12. Relative afferent pupillary defect was positive in the right eye. In funduscopic examination, both of optic nerve head were atrophy. Left eye visual field examination revealed temporal hemianopsia.
 Cerebral MRI showed a hyper intense lesion on both T1WI and T2WI sequence in sellar region that extends into supra sellar region with sign of sellar floor ballooning. The result of MRI contrast was relatively same and the hormonal exam result was within normal limit. Then he was scheduled for removal tumor surgery from neurosurgery departement.
 Conclusion : Pituitary apoplexy is a severe clinical syndrome and life-threatening disease. To rule out other disease presenting related symptoms, many ancillary examinations are require to be performed. The treatment of pituitary apoplexy, whether to treat surgically or conservatively, should be made by experts from a multidisciplinary team.

A differentiated approach to the treatment of pituitary apoplexy

A differentiated approach to the treatment of pituitary apoplexy

Early diagnosis and treatment of pituitary apoplexy in a diabetic pregnant woman

Searchable abstracts of presentations at key conferences in endocrinology ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endoscopic Treatment of Pituitary Apoplexy: Outcomes in a Series of 10 Patients

Endoscopic Treatment of Pituitary Apoplexy: Outcomes in a Series of 10 Patients

Pituitary apoplexy: evaluation, management, and prognosis

To review the current standard of care in the diagnosis and treatment of pituitary apoplexy and to determine any updated clinical management strategies. Pituitary apoplexy is a rare but life-threatening medical emergency. Presenting signs and symptoms often include severe headache, visual loss, ophthalmoplegia, altered consciousness, and impaired pituitary function. Common predisposing factors include closed head trauma, blood pressure alterations, history of pituitary irradiation, cardiac surgery, anticoagulation, treatment with dopamine agonists, pituitary stimulation testing, and pregnancy. MRI imaging is the most sensitive sequence for the detection of acute and old intracranial hemorrhage. Patients often require emergent intravenous fluids, blood transfusions, and high-dose corticosteroids. Patients who remain clinically and neurologically unstable require urgent transsphenoidal surgical decompression as definitive treatment. In patients with pituitary apoplexy, improvement in visual field defects, visual acuity, and diplopia is typically observed after emergent application of therapy, often including medical and surgical treatment. Some patients may require long-term hormonal therapy after surgery.

The “Pituitary Ring Sign”: An MRI Sign of Pituitary Apoplexy

Purpose: To describe a magnetic resonance imaging (MRI) sign of pituitary apoplexy. Methods: The cranial MRI scans of 3 patients with pituitary apoplexy were retrospectively reviewed. Results: All 3 patients displayed a distinctive MRI sign of an enlarged pituitary gland with peripheral gadolinium enhancement surrounding a hypointense gland. Conclusions: The “pituitary ring sign” can aid in the early diagnosis and treatment of pituitary apoplexy.

Pituitary Apoplexy

Learning Objectives: After reading this article, the participant should be able to: 1. Identify the clinical manifestations of pituitary apoplexy. 2. Describe the radiographic characteristics of pituitary apoplexy. 3. Recall the importance of rapid diagnosis and treatment of pituitary apoplexy.

Apoplejía hipofisaria

Pituitary apoplexy is an infrequent complication of pituitary adenomas, caused by hemorrhagic or ischemic infarction in the tumor, with typical clinical presentation: severe headache of sudden onset, visual disturbances, sleep tendency or comma. Along the last ten years we have treated eight patients with pituitary apoplexy. The diagnostic was clinically established in all of them. Seven cases complained of severe headache and vomiting. Eight patients reported visual disturbances. In one case low level of consciousness and meningeal irritation were the only findings. In six cases the apoplexy was the first pituitary adenoma manifestation. MRI and CT studies demonstrated the pituitary stroke in seven patients. Surgical trans-sphenoidal decompression was performed in seven patients, requiring urgent management in only one case. All patients experienced a marked visual improvement, but there was no amelioration of endocrine preoperative disturbances in any case. We conclude that quick diagnosis, early onset of hormonal therapy and urgent or delayed trans-sphenoidal surgery, depending on clinical manifestations, constitute the principies of the appropriate treatment of pituitary apoplexy.