Acute hypopituitarism associated with periorbital swelling and cardiac dysfunction in a patient with pituitary tumor apoplexy: a case report
Nobumasa OharaYuichiro YoneokaYasuhiro SekiKatsuhiko AkiyamaMasataka AritaKazumasa OhashiKazuo SuzukiToshinori Takada
1
Citation
11
Reference
10
Related Paper
Citation Trend
Abstract:
Pituitary tumor apoplexy is a rare clinical syndrome caused by acute hemorrhage or infarction in a preexisting pituitary adenoma. It typically manifests as an acute episode of headache, visual disturbance, mental status changes, cranial nerve palsy, and endocrine pituitary dysfunction. However, not all patients present with classical symptoms, so it is pertinent to appreciate the clinical spectrum of pituitary tumor apoplexy presentation. We report an unusual case of a patient with pituitary tumor apoplexy who presented with periorbital edema associated with hypopituitarism. An 83-year-old Japanese man developed acute anterior hypopituitarism; he showed anorexia, fatigue, lethargy, severe bilateral periorbital edema, and mild cardiac dysfunction in the absence of headache, visual disturbance, altered mental status, and cranial nerve palsy. Magnetic resonance imaging showed a 2.5-cm pituitary tumor containing a mixed pattern of solid and liquid components indicating pituitary tumor apoplexy due to hemorrhage in a preexisting pituitary adenoma. Replacement therapy with oral hydrocortisone and levothyroxine relieved his symptoms of central adrenal insufficiency, central hypothyroidism, periorbital edema, and cardiac dysfunction. Common causes of periorbital edema include infections, inflammation, trauma, allergy, kidney or cardiac dysfunction, and endocrine disorders such as primary hypothyroidism. In the present case, the patient’s acute central hypothyroidism was probably involved in the development of both periorbital edema and cardiac dysfunction. The present case highlights the need for physicians to consider periorbital edema as an unusual predominant manifestation of pituitary tumor apoplexy.Keywords:
Pituitary apoplexy
Pituitary Tumors
Lethargy
Pituitary apoplexy
Transsphenoidal surgery
Pituitary Tumors
Cite
Citations (1)
Objective To compare the pituitary functions of patients with acute pituitary apoplexy before and after transsphenoidal surgery.Methods The clinical data and results of endocrine examination in 25 cases of acute pituitary apoplexy treated with transsphenoidal surgery were retrospectively analyzed.Before the operation,9 patients suffered pituitary-thyroid function impairment,14 sustained impaired pituitary-adrenal function,and 11 had impairment of the pituitary-gonadal function.Thirteen patients were operated within 3 days after admission and 12 within 1 week.Results After the operation,5 of the 9 patients with hypothyroidism,8 of the 14 with hypoadrenocorticism,and 7 of the 11 with hypogonadism recovered from the hypopituitarism.Conclusion Hypopituitarism is a major manifestation of acute pituitary apoplexy,and timely surgical decompression may benefit the improvement of pituitary function.Patients with hypopituitarism after surgery require corresponding hormone replacement therapy.
Pituitary apoplexy
Pituitary disease
Transsphenoidal surgery
Cite
Citations (0)
Hypopituitarism is defined as deficiency of all anterior pituitary hormone1. Panhypopituitarism is defined when there is deficiency of both anterior and posterior pituitary hormone. In this case report our 50 year old male diagnosed with pituitary apoplexy (bleeding in rathke’s pouch) started on intravenous steroids and later on oral steroids and he started improving clinically.
Pituitary apoplexy
Cite
Citations (0)
A patient, 38-year-old man, with hemorrhage into a prolactin-secreting pituitary adenoma, or pituitary apoplexy, is reported. On his admission, clinical examinations revealed typical stigmata indicating that he suffered from an acute attack of pituitary apoplexy probably induced by acute meningitis. He survived the acute attack and recovered spontaneously without an urgent operation. Although there was no suspicious sign and symptom of hypopituitarism, the first study performed immediately after the attack suggested strongly that hypopituitarism might acutely developed during the hemorrhage into the tumor. Moreover, the follow-up studies indicated that TSH, LH and ADH recovered spontaneously from the initial damage following the resorption of hemorrhage for the next 3 months.
Pituitary apoplexy
Cite
Citations (1)
The assessment of pituitary function makes hormone replacement more timely for hypopituitarism after surgical procedure in patients with pituitary adenoma.However,there were only less than 50％ patients receiving this assessment in the current clinical practice.Only by means of the cooperation between endocrinologists and neurosurgeons and the close contact between doctors from both tertiary and primary hospitals will reach the goal of the patient-centered treatment and appropriately improve the defective therapy of the pituitary adenoma.
Key words:
Pituitary adenoma; Assessment of pituitary function ; Hypopituitarism
Cite
Citations (0)
Pituitary apoplexy
Transsphenoidal surgery
Pituitary disease
Cite
Citations (2)
Although the incidence and clinical manifestations of pituitary apoplexy were reported by a few researches, the results are not consistent. This study aimed to explore the risk factors associated with an incidence of apoplexy in pituitary adenomas.The clinical information of 843 patients with pituitary adenoma from the Department of Neurological Surgery, 1st Affiliated Hospital of Kunming Medical University, was reviewed. The incidence, clinical manifestation, and potential risk factors for pituitary apoplexy were analyzed by a case-control study.In total, 121 patients (14.4%) with macroadenoma were suffered from pituitary apoplexy. Headache, vomiting, and visual impairment are the top 3 symptoms for the pituitary apoplexy.Logistic regression results showed that the hypertension(hypertension vs non-hypertension OR = 2.765, 95%CI:1.41~5.416), tumor type (negative staining vs. positive staining, OR = 1.501, 95%CI:1.248~5.235), and tumor size (diameter > 2 cm vs. diameter ≤ 2 cm, OR = 3.952, 95%CI:2.211~7.053) are independent factors associated with pituitary apoplexy.Our results indicate that the risk factors for the incidence of pituitary apoplexy depend mainly on properties of the tumor itself (tumor size and pathologic type) and the blood pressure of patients.
Pituitary apoplexy
Pituitary Tumors
Single Center
Cite
Citations (17)
Pituitary apoplexy
Neuroradiology
Cite
Citations (15)
Pituitary apoplexy is an endocrine emergency, which commonly presents as hypopituitarism. Prompt diagnosis and treatment can be both life and vision saving. There are a growing number of published case reports postulating a link between COVID-19 and pituitary apoplexy. We report the case of a 75-year-old man who presented with a headache and was later diagnosed with hypopituitarism secondary to pituitary apoplexy. This occurred 1 month following a mild-to-moderate COVID-19 infection with no other risk factors commonly associated with pituitary apoplexy. This case, therefore, supplements an emerging evidence base supporting a link between COVID-19 and pituitary apoplexy.
Pituitary apoplexy
2019-20 coronavirus outbreak
Pituitary disease
Cite
Citations (15)
Cause of pituitary apoplexy has been known as hemorrhage, hemorrhagic infarction or infarction of pituitary adenoma or adjacent tissues of pituitary gland.However, pituitary apoplexy caused by pure infarction of pituitary adenoma has been rarely reported.Here, we present the two cases pituitary apoplexies caused by pituitary adenoma infarction that were confirmed by transsphenoidal approach (TSA) and pathologic reports.Pathologic report of first case revealed total tumor infarction of a nonfunctioning pituitary macroadenoma and second case partial tumor infarction of ACTH secreting pituitary macroadenoma.Patients with pituitary apoplexy which was caused by pituitary adenoma infarction unrelated to hemorrhage or hemorrhagic infarction showed good response to TSA treatment.Further study on the predisposing factors of pituitary apoplexy and the mechanism of infarction in pituitary adenoma is necessary.10.
Pituitary apoplexy
Pituitary Tumors
Cite
Citations (29)