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Query: UMLS:C0018681 (headache)
 56,091 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Pituitary apoplexy, characterized by sudden onset or acute progression of signs and symptoms of pituitary adenoma, is rare yet well-known. One such case is presented with clinical course, neuroradiological findings and autopsy. A 53-year-old female complained of sudden onset of severe headache, and rapidly deteriorated in the level of consciousness. Five days later, she became comatose and was admitted to National Sendai Hospital. Plain skull films and carotid angiograms revealed a remarkably large mass in the pituitary fossa. Death came ten hours after admission. Autopsy revealed a giant tumor (10 X 5 X 7.5 cm) destroying the sella turcica and protruding toward both the nasopharyngeal cavity and the hypothalamic region. Microscopically, diagnosis was made as chromophobe adenoma with fresh hemorrhage in the tumor.
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PMID:[Pituitary apoplexy of giant pituitary adenoma--case report (author's transl)]. 59 22

Pituitary Apoplexy is a rare but sometimes life threatening condition which requires prompt recognition and timely medical intervention to avoid catastrophic consequences. From January 1979 to June 1989 and total of one hundred and ninety eight pituitary tumor patients were operated on our hospital. Eighteen cases (9.1%) were diagnosed "pituitary apoplexy" according to histopathological findings. The group consisted of twelve men and six women ranging in age from twenty two to sixty one years with a mean of forty. There were three cases of prolactin-secreting adenomas (16.7%), four growth-hormone secreting adenomas (22.2%), and eleven nonfunctional adenomas (61.1%) with an incidence of 6.1%, 8.3%, and 11.4% respectively (P > 0.05). Clinical manifestation occurred acutely in 66.7% and nonacutely in 33.3%. The patients presented with headaches (100%), visual impairment (83.3%), visual field defects (66%), disturbed consciousness (22%), fever and meningismus (11%). Radiological examinations able to demonstrate abnormalities included plain skull films (84%), computed tomography (84.6%), and angiography (93.8%). Various investigations of endocrine function pre and post operatively showed a deficient gonad axis (53%, 62.5%), adrenal axis (26.7%, 56.2%), and thyroid axis (20%, 43.8%). Sixteen cases received a transsphenoid operation and three cases underwent a transfrontal craniotomy. No case of mortality was reported. Postoperative radiotherapy was given to nine cases and nine cases were followed up on a regular basis. Therefore, our retrospective study suggests that pituitary apoplexy is not uncommon and has an acute clinical presentation. No particular tumor type was prone to occur. Various radiological examinations could define perisellar abnormalities. With a decreasing order of hormone deficiency, gonad, adrenal and thyroid axis were observed during the course of treatment.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:[Pituitary apoplexy: a study of eighteen cases]. 133 26

A 40-year-old patient presented with intractable headache, panhypopituitarism and diabetes insipidus 5 months after a severe shock syndrome. The magnetic resonance imaging of the brain confirmed a hemorragic necrosis of the pituitary gland. On follow-up, the patient recovered a normal pituitary function, except for the persistence of a partial ACTH deficiency. The pituitary image also normalized. Pituitary apoplexy is a rare disease of severe prognosis due to its neurological and endocrine consequences. It can now be more easily recognized by the new imaging techniques.
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PMID:Spontaneous pituitary apoplexy with transient panhypopituitarism and diabetes insipidus. 164 16

Pituitary apoplexy describes the clinical syndrome characterised by headache, visual impairment and ophthalmoplegia caused by sudden enlargement of a pituitary adenoma. This is usually due to extensive tumour infarction or haemorrhage. Pituitary apoplexy is rare, mimics spontaneous intracranial bleeding, and thus may be easily mistaken for acute subarachnoid haemorrhage. Urgent surgical intervention and hormone replacement therapy are required.
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PMID:Bleeding intracranial aneurysm? Pituitary apoplexy! 179 4

Pituitary apoplexy, an uncommon syndrome, presented in a 40-year-old Nigerian with severe impairment of vision and persistent headaches over a 4-month period. Surgical decompression successfully restored his vision. This case is presented with a review of the literature and discussed as the first case seen in this unit since it started 5 years ago.
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PMID:A case of pituitary apoplexy. 211 24

Pituitary apoplexy is characterized by a wide spectrum of clinical features. A quite rare case of painless thyroiditis, hypopituitarism and central diabetes insipidus (DI) followed by pituitary apoplexy was presented. A 61-year-old woman was admitted to our hospital in May, 1986 because of marked general malaise, polydipsia and weight loss which became progressively worse. Four months earlier she had experienced episodes of abrupt onset of severe headache associated with nausea and blurring vision. Physical examinations revealed a fine tremor, dry skin and nervousness. The thyroid gland was not palpable. Visual fields were intact. Her blood pressure was 105/64 mmHg with variable tachycardia. The routine laboratory studies were normal or negative except for hypoalbuminemia, hypocholesterolemia and hypernatremia. Erythrocyte sedimentation rate was 12 mm/hr. An impairment in corticotropin secretion was suspected from the low plasma cortisol and the low urinary excretion of 17-OHCS and the sufficient response to ACTH. Basal levels of GH and gonadotropin were also low, and responses to the stimulation tests (Insulin-stress, L-DOPA, and LH-RH) were all blunted. Brain computed tomographic scan and magnetic resonance imaging demonstrated a suprasellar mass that, after infusion, developed peripheral ring-like enhancement and large hyperintense pituitary mass, respectively. A diagnosis of pituitary apoplexy with anterior pituitary failure was made. However, the initial levels of thyroid hormones showed elevated as follows: Free T3 7.6 pg/ml, Free T4 3.3 ng/dl and T3-resin uptake 41.1%. TSH responses to TRH were all suppressed. TSH receptor antibody (TBII) was negative. Both antithyroglobulin and antimicrosomal antibodies were repeatedly positive. A thyroid scan with 99mTc revealed no uptake in the thyroid area. These findings led us to the diagnosis of "painless autoimmune thyroiditis". She had become hypothyroid without any medication. At that time radioactive 99mTc and 123I uptakes increased significantly. When hydrocortisone was substituted, daily urine output abruptly increased to about 10 liters with low osmolality, and the presence of DI was suspected. This diagnosis was confirmed by water deprivation and hypertonic saline infusion tests and subsequent pitressin test. She is currently quite well on L-thyroxine, hydrocortisone and desmopressin (1988). This association with pituitary apoplexy must be a rare occurrence, as a literature search has failed to find a similar case. The pathogenetic trigger of "painless thyroiditis" in this case may be responsible for some immunological change due to secondary adrenal insufficiency after pituitary apoplexy.
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PMID:[An unusual association of transient resolving thyrotoxicosis due to painless thyroiditis, hypopituitarism and central diabetes insipidus associated with spontaneous pituitary apoplexy]. 230 57

Pituitary apoplexy, a rare neurological emergency resulting from pituitary haemorrhage or infarction, should be considered a possibility in patients presenting with headache. Six cases are reported. The patients, four females and two males, ranged in age from 18 to 53 years. In only two had pituitary pathology previously been recognised. Headache occurred in all patients, visual field defects in four, ocular paresis in two, and subsequent hypopituitarism in five. The headache type suggested intracranial catastrophe in only one patient. A possible precipitant was noted for three of the episodes, including, in one patient, salmonella gastroenteritis. Cortisol deficiency during the acute event was common. Semi-urgent surgery was performed in two patients. In two others, prompt resolution of symptoms occurred following administration of dexamethasone.
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PMID:Pituitary apoplexy. 270 61

Pituitary apoplexy with acute visual loss has to be considered as emergency operative indication. 3 cases presenting headache, rapid visual deterioration and ophthalmoplegia were operated upon from a transphenoidal approach. Immediate operative decompression proved to resolve the acutely evolved symptoms in all 3 cases.
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PMID:[Hypophyseal apoplexy, an urgent indication for surgery]. 376 62

Two cases of pituitary apoplexy were detected in the immediate postoperative period after cardiac surgery with extracorporeal bypass. Both patients had pituitary adenomas that were asymptomatic and previously undiagnosed. One patient, a 57-year-old man, had unilateral total ophthalmoplegia and blepharoptosis with sparing of the visual system. The second patient, a 55-year-old man, had headache, marked bilateral visual loss, and ophthalmoplegia with subsequent development of a hemiparesis. Pituitary apoplexy was confirmed pathologically in both cases. Hemodynamic instability during and immediately after surgery and anticoagulation are probable precipitating factors.
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PMID:Pituitary apoplexy associated with cardiac surgery. 633 39

Pituitary apoplexy is a rare but sometimes dramatic complication of pituitary tumors. We report the case of a 64-year-old man with a macroadenoma who complained of a sudden and intense headache after a dynamic TRH (200 micrograms) and GnRH (100 micrograms) test. Two days later, he presented an acute ophthalmoplegia with fever and deteriorating consciousness. Emergency CT scan showed contrast hypofixation compatible with necrosis of the adenoma. Surgical, tumoral decompression resolved quickly almost all symptoms. Immunohistochemical study of the tumor confirmed the diagnosis of gonadotropinoma. Several similar cases of pituitary apoplexy occurring after TRH or GnRH tests have been described the last ten years. As this test may sometimes confirm the diagnosis of gonadotropinoma, it should be performed with caution in cases of clinically non functioning pituitary macroadenoma.
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PMID:[Pituitary apoplexy of a gonadotrophinoma and TRH/GnRH tests. Literature review]. 763 32


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