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Analytic Review: Pituitary Tumor Apoplexy: A Review


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http://jic.sagepub.com/cgi/content/abstract/23/2/75

 

Journal of Intensive Care Medicine, Vol. 23, No. 2, 75-90 (2008)

DOI: 10.1177/0885066607312992

? 2008 SAGE Publications

Reviews

 

Analytic Review: Pituitary Tumor Apoplexy: A Review

Rita N. Nawar, MD Division of Clinical and Molecular Endocrinology, University Hospitals Case Medical Center and Case Western Reserve University

 

Dima AbdelMannan, MD

 

Division of Clinical and Molecular Endocrinology, University Hospitals Case Medical Center and Case Western Reserve University

 

Warren R. Selman, MD

 

Department of Neurological Surgery University Hospitals Case Medical Center and Case Western Reserve University, Cleveland, Ohio

 

Baha M. Arafah, MD

 

Division of Clinical and Molecular Endocrinology, University Hospitals Case Medical Center and Case Western Reserve University, baha.arafah@case.edu

 

Pituitary tumor apoplexy is an uncommon syndrome resulting oftenspontaneously from hemorrhage or infarction of a pre-existingpituitary adenoma. As the primary event involves the adenoma,the syndrome should be referred to as pituitary tumor apoplexyand not as pituitary apoplexy. The sudden increase in sellarcontents compresses surrounding structures and portal vessels,resulting in sudden, severe headache, visual disturbances, andimpairment in pituitary function. Initial management of patientswith pituitary tumor apoplexy includes supportive therapy (intravenousfluids and corticosteroids), following which many patients exhibitclinical improvement. Because those patients can be effectivelymanaged with supportive measures, many who remain clinicallyand neurologically unstable might benefit from urgent surgicaldecompression by an experienced neurosurgeon. All patients presentingwith this syndrome require long-term follow-up to treat anyresidual tumor and/or pituitary dysfunction. Close interactionbetween members of the management team is necessary for optimalpatients' outcome.

 

 

 

Key Words: apoplexy ? pituitary adenoma ? hypopituitarism ? headache ? visual field deficits ? cranial nerve palsy

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Thanks for the interesting information Mary. I was told by a doctor before my diagnosis (after he looked at my pituitary MRI) that he thought this might have happened to me somewhere along the line. I think my partially empty sella goes along with the conclusion he made on this too.

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Terry,

 

This just showed up on my last MRI (after two pit surgeries and two surgeries to repair CSF leaks). Mine probably isn't apoplexy . . . . the best explanation that I can find is that due to the CSF leaks (I guess) my menengies has "preforated" into the sella and pressed what little pituitary I have left, against the wall of the sella.

 

Hmmm . . . . who knows! I can't wait until my appt. with the neurologist so that I can ask 1000 questions! :scooter:

 

Intracranial hypertension (which we are pretty sure I have) can cause empty sella and both cause headaches. So that's an answer as to the severe, debilitating headaches that I've been having.

 

Sorry for the misspelled words . . . . my brain is too tired today!

 

Hugs

Amy

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Terry,

 

This just showed up on my last MRI (after two pit surgeries and two surgeries to repair CSF leaks). Mine probably isn't apoplexy . . . . the best explanation that I can find is that due to the CSF leaks (I guess) my menengies has "preforated" into the sella and pressed what little pituitary I have left, against the wall of the sella.

 

Hmmm . . . . who knows! I can't wait until my appt. with the neurologist so that I can ask 1000 questions! :sweat:

 

Intracranial hypertension (which we are pretty sure I have) can cause empty sella and both cause headaches. So that's an answer as to the severe, debilitating headaches that I've been having.

 

Sorry for the misspelled words . . . . my brain is too tired today!

 

Hugs

Amy

 

I'm sorry that you have had to go through so much Amy. Those headaches sound terrible. When is your next appointment with your neurologist? I hope he answers all of your questions and I also hope you get some resolution for your headaches.

 

Take care and hang in there.

 

Hugs,

 

Terry

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Thanks for posting this Mary. I did some reserach over a year ago when I started to experience various symptoms. The first diagnosis I was given was optical neuritis and possible MS. Not convinced I looked into it further and found articles on pituitary appoplexy that described exactly what had happened to me. I suggested it to my endo who was initially not convinced until he spoke to my neurosurgeoen and then an official diagnosis of pituitary appoplexy was confirmed. My inital symptoms were severe headache resulting in partial loss of sight in my left eye (about 90%) - fortunately my sight came back over time but has not fully returned. Also at the time I suffered spasms in my ankles and legs which were uncontrollable (hence the concern that it could be MS).

 

The odd thing that happened though with me is that my tumour enlarged and then collapsed into itself and started to shrink. Despite this I still suffered a reccurrance when I should have by all accounts been headed for a cure.

 

The other odd thing is what is happening with me now, its been another year since I was diagnosed with pituitary appoplexy and this week some of the symptoms I had back then have started to happen again - cramping in the ankles, painful headaches etc - I know I am cyclical but this is ridiculous, surely pit appoplexy can't cycle as well....can it?

 

Diane

x

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This is very interesting!

 

Sandy was told she had this when at NIH and was AI. It all turned around later tho. Her later pit surgery involved a large tumor. So maybe there was apoplexy and then regrowth?

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