Pituitary apoplexy complicated with subarachnoid hemorrhage caused by incidentaloma following a head injury: Case report

Department of Neurosurgery, First Hospital of China Medical University, Shenyang 110001, China.
Chinese medical journal (Impact Factor: 1.05). 01/2008; 120(24):2341-3.
Source: PubMed

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    [Show abstract] [Hide abstract] ABSTRACT: To assess frequency, symptoms and outcome of pituitary apoplexy (PA) among pituitary adenoma patients, to gain better insight into risk factors for bleeding into pituitary adenoma and to estimate the sequelae of PA by means of a matched control group. By reviewing charts of 574 patients with pituitary adenoma, we analysed incidence, symptoms and outcome of PA and potential risk factors for developing PA by means of a control group (patients with pituitary adenoma without PA). In total, 42 suffered from PA, all had macroadenomas; 30/217 male (14%) and 12/179 female (7%) macroadenoma patients, 32/194 patients with clinically non-functioning (16.5%) and 10/202 with clinically active (5.0%) macroadenoma were affected. Antithrombotic therapy predisposed patients to PA (P=0.026), diabetes mellitus and hypertension did not (P=1.00). Patients with PA and pituitary adenoma patients without PA had similar frequencies of hypopituitarism (45 vs 48%, P>0.05) and visual field defects (38 vs 55%, P>0.05), but ophthalmoplegia was significantly more common (76 vs 5%, P<0.001) in patients with PA. Nearly all patients were treated by surgery; most recovered from ophthalmoplegia, whereas visual function improved only moderately. Endocrine outcome was worse in patients with PA than in patients without PA. Male sex and characteristics of the adenoma itself (especially tumour size and tumour type) rather than patient's cardiovascular risk factors such as diabetes and hypertension seem to predispose to PA; antithrombotic therapy may also be important.
    Full-text · Article · Oct 2010 · European Journal of Endocrinology
  • [Show abstract] [Hide abstract] ABSTRACT: Pituitary apoplexy is an uncommon syndrome typically resulting from ischaemic or haemorrhagic necrosis of an existing pituitary adenoma. Patients classically present with sudden-onset severe headache, reduced consciousness, and meningeal irritation. For this reason, the clinical picture is frequently mistaken as being caused by aneurysmal subarachnoid haemorrhage (SAH). It is necessary to distinguish preoperatively between pituitary apoplexy and SAH as there are reports of inappropriate craniotomy being performed with a view to clipping nonexistent aneurysms. Importantly, transsphenoidal excision of a pituitary adenoma risks rupture of an unidentified intracranial aneurysm. This is particularly significant given the established association between pituitary adenoma and development of intracranial aneurysms. This chapter reviews the epidemiology and pathophysiology underlying the relationship between pituitary tumours, intracranial aneurysms, and SAH. It also makes evidence-based recommendations for the investigation of patients with suspected pituitary apoplexy to identify associated conditions preoperatively and manage the risk of iatrogenic aneurysm rupture. © 2014 Springer-Verlag Berlin Heidelberg. All rights are reserved.
    No preview · Article · Aug 2013
  • [Show abstract] [Hide abstract] ABSTRACT: Pituitary apoplexy is a rare threatening condition, still often misdiagnosed. In line with this the treating physician should be aware of pituitary apoplexy as a potential diagnoses whenever a patient seeks care with acute-onset headache associated with visual loss, ophthalmoparesis and altered mental status. In line with this there are several known predisposing factors that may lead to pituitary apoplexy as well, and eventually their early identification will be a clue to diagnosis or will help tailor patient management. Herein, our aim is to focus on these factors associated with pituitary apoplexy grouped into six major categories: associated medical conditions, surgery, head trauma and endocrinological testings.
    No preview · Chapter · Jan 2014