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 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

This paper presents an overview of the evolution of pituitary surgery for acromegaly. It begins with the first case, attempted in 1893, through the initial transsphenoidal successes in 1907-1910, to the development of effective craniotomy approaches, and ultimately to the resurrection of the transsphenoidal approach in the 1970s and thereafter. Today, the minimally endoscopic transnasal endoscopic approach is fast becoming the norm. Indications for surgery include active acromegaly, visual loss and other forms of mass effect, pituitary tumor apoplexy, and failure of other therapies (medical, radiation). Contraindications include advanced age, debility or other medical conditions increasing the risk of general anaesthesia or surgery. Surgery for acromegaly has the advantage of immediate lowering of the growth hormone excess, with endocrine remission rates of 70% for microadenomas and 50% for macroadenomas. When surgery fails to obtain remission, a program of therapy is designed for the patient to include adjunctive medical therapy (dopamine agonists, somatostatin analogs, and growth hormone receptor antagonists), radiation therapy or radiosurgery (Gamma knife, Cyberknife, etc.).
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PMID:Surgery for acromegaly: evolution of the techniques and outcomes. 1822 47

Pituitary tumor apoplexy is an uncommon syndrome resulting often spontaneously from hemorrhage or infarction of a pre-existing pituitary adenoma. As the primary event involves the adenoma, the syndrome should be referred to as pituitary tumor apoplexy and not as pituitary apoplexy. The sudden increase in sellar contents compresses surrounding structures and portal vessels, resulting in sudden, severe headache, visual disturbances, and impairment in pituitary function. Initial management of patients with pituitary tumor apoplexy includes supportive therapy (intravenous fluids and corticosteroids), following which many patients exhibit clinical improvement. Because those patients can be effectively managed with supportive measures, many who remain clinically and neurologically unstable might benefit from urgent surgical decompression by an experienced neurosurgeon. All patients presenting with this syndrome require long-term follow-up to treat any residual tumor and/or pituitary dysfunction. Close interaction between members of the management team is necessary for optimal patients' outcome.
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PMID:Pituitary tumor apoplexy: a review. 1837 48

A 40-year-old man presented with a sudden severe headache and complete right-sided ptosis. Neuro-ophthalmic examination revealed a right oculomotor nerve palsy. Computed tomography of the brain showed a round isodense intrasellar mass. Magnetic resonance imaging demonstrated a pituitary tumor with some areas of infarction and invasion into the right cavernous sinus, which was diagnosed as pituitary apoplexy. The patient received intravenous steroid for 10 days with no recovery of the oculomotor nerve palsy. He underwent trans-sphenoid tumor resection followed by complete recovery of the oculomotor nerve and no sign of tumor in postoperative MRI, two weeks after the surgery.
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PMID:Pituitary apoplexy presenting as acute painful isolated unilateral third cranial nerve palsy. 1858 83

The clinical features of 426 pituitary adenomas were retrospectively analyzed, focusing on the factors that affect the development of pituitary apoplexy. Immunohistochemical analysis was used to define the different hormone types of the tumors and the expression of various immunologic targets, including the pituitary tumor transforming gene, basic fibroblast growth factor-2, matrix metalloproteinase-9, tissue inhibitor of metalloproteinase-1, and proliferating cell nuclear antigen. Of the 426 patients, 83 presented with pituitary apoplexy (19.48%). Among them, 43 patients (43/83, 51.82%) developed apoplexy in the absence of any obvious precipitating factor. Clinical manifestations included headaches (80/83, 96.38%), vision loss (69/83, 83.13%), pituitary function change (51/83, 61.45%), visual field defects (41/83, 49.39%), and nausea and vomiting (34/83, 40.96%). Male patients and patients with functional adenoma had a higher probability of developing apoplexy. Complicated immunological expression patterns were found in adenomas associated with pituitary apoplexy, with adenomas of different hormone types identified.
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PMID:Clinical features and immunohistochemical changes of pituitary apoplexy. 1904 83

Pituitary tumor apoplexy is a medical emergency due to acute infarction or hemorrhage in the pituitary gland. In this review, the authors discuss the sellar anatomy, the pituitary gland and adenomas' vascularization and the general aspects of the syndrome such as its ethiopatogenesis, predisposing factors, clinical features, treatment and prognosis.
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PMID:Pituitary tumor apoplexy. 1954 36

We report the case of a 60 year old male who complained of headache and blurry vision--that progressed to left ophthalmoplegia and ptosis--after receiving a dose of leuprolide for Prostate cancer therapy. Imaging showed a hemorrhagic sellar mass. The patient underwent transsphenoidal debulking, and the tissue obtained demonstrated immunohistochemical staining for LH. A literature review revealed nine previously reported cases of pituitary apoplexy after GnRH agonist therapy for prostate cancer. In most cases, the sellar tissues stained for LH, consistent with a gonadotropinoma. The pathophysiology of these events is unclear, but recent animal models suggest possible explanations. The predominance of gonadotropinomas is important because they do not usually present with hypersecretory symptoms. Particular attention to clinical findings suggestive of a non functioning pituitary tumor in patients receiving GnRH agonist therapy is critical as routine screening with MRI is not practical.
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PMID:Apoplexy in non functioning pituitary adenoma after one dose of leuprolide as treatment for prostate cancer. 1984 40

The clinical and radiological findings of a patient affected by apoplexy of an adenoma located within cavernous sinus and presenting isolated Cranial Nerve (CN) VI palsy are reported. The differential diagnosis with other pathologies is debated, and pathogenesis of isolated abducens nerve palsy is investigated. The pertinent literature of this uncommon case of apoplexy is reviewed. A 59-year-old female presented sudden appearance of CN VI palsy associated to violent headache. Endocrinological assessment did not show pituitary insufficiency; MRI depicted an adenoma located within the left CS. She underwent an endoscopic endonasal procedure with extensive opening of the cavernous sinus, occupied by an ischemic adenoma. Afterward, neurological symptoms promptly resolved and the patient was discharged after 5 days. At 3 months follow-up MRI radical tumor removal was assessed, and the patient resulted neurologically intact. The review of the pertinent literature shows that apoplexy of pituitary tumor exclusively located within the Cavernous Sinus is a very uncommon event. The distinctive clinical presentation is represented by the sudden abducens nerve palsy and the absence of pituitary insufficiency and it could be explained by the vulnerability of the nerve along its course within the cavernous sinus, and by the sparing of the sellar content by the adenoma.
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PMID:Cavernous sinus apoplexy presenting isolated sixth cranial nerve palsy: case report. 2150 86

We present a rare case with pituitary apoplexy after three-vessel off-pump coronary artery bypass grafting (OPCAB). The patient exhibited right third cranial nerve palsy; ptosis of the right eye with completely dilated pupils and a loss of reflex to light after the effects of anesthesia completely subsided. The patient underwent endonasal transsphenoidal resection of the pituitary gland 14 days after the OPCAB, and the symptoms completely disappeared 40 days after the resection. OPCAB is recommended for patients with known pituitary tumor who require coronary artery bypass grafting, but OPCAB also has a risk of pituitary apoplexy. The present case report is the first to describe pituitary apoplexy after OPCAB. Pituitary apoplexy is a very rare complication after cardiac surgery, but cardiac surgeons should know the disease and quickly diagnose it to avoid severe brain injury.
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PMID:Pituitary apoplexy with third cranial nerve palsy after off-pump coronary artery bypass grafting. 2152 63

Pituitary tumor apoplexy refers to a clinical syndrome precipitated by the expansion of a pituitary adenoma by hemorrhage or infarction. Individuals may present with myriad signs, including sudden onset of severe headache, visual changes, altered mental status, cranial nerve palsies, and hormonal dysfunction. This disorder constitutes a medical emergency and warrants an expedited evaluation, diagnosis, and treatment to prevent the potential sequelae of permanent visual loss, endocrine abnormalities, or death. We report a case of sudden death from undiagnosed pituitary tumor apoplexy. The decedent was evaluated by medical personnel on three occasions in the week prior to her death for severe headache, nausea, vomiting, and photophobia. Postmortem examination demonstrated a hemorrhagic infarction of a pituitary adenoma with necrosis and expansion out of the sella turcica. The recognition of and treatment for a patient with pituitary tumor apoplexy requires a rapid multidisciplinary effort. Failure of prompt diagnosis may be fatal and require a medico-legal death investigation for sudden and unexpected death.
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PMID:Sudden and unexpected death from pituitary tumor apoplexy. 2185 88

Pituitary tumor apoplexy is a rare neuroendocrine syndrome resulting, in most cases, from hemorrhage or infarctation of a pre-existing pituitary adenoma. Treatment recommendations vary; some authors advocate urgent surgical decompression of the tumor, whereas others suggest that conservative management can lead to recovery of neuro-ophthalmologic function. We describe two patients with pituitary tumor apoplexy who had clinically non-functioning macroadenomas and hypopituitarism, including hypogonadism. They were treated conservatively without surgery, and achieved tumor remission.
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PMID:Conservative management of pituitary tumor apoplexy. 2188 18


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