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Twelve Cases of Pituitary Apoplexy

Twelve Cases of Pituitary Apoplexy Abstract In 12 cases of pituitary apoplexy, a preexisting unsuspected adenoma was found. The initial manifestations were sudden onset of headache (12 patients), signs of meningeal irritation (10) with fever (four), altered consciousness (12), and ophthalmologic disturbances (eight). The diagnosis was retrospective in three cases. Radiologic investigations were always suggestive if carefully considered. The plain skull roentgenograms, in particular, showed an enlarged sella turcica in 11 cases. Three patients had prolactin adenomas, and nine had nonfunctional adenomas. Medical treatment was successful in only three patients; surgery was performed in 10 cases by means of a sublabial transseptal microsurgical approach. Postoperative neurologic complications were serious in two cases. Endocrine insufficiencies were common: eight cases of permanent panhypopituitarism, two cases of pluritropic anterior pituitary dysfunction, and three cases of persistent hyperprolactinemia. (Arch Intern Med. 1992;152:1893-1899) References 1. Ebersold MJ, Laws ER, Scheithauer BW, Randall RV. Pituitary apoplexy treated by transphenoidal surgery: a clinicopathological and immunocytological study . J Neurosurg. 1983;58:315-320.Crossref 2. Mohr G, Hardy J. Hemorrhage, necrosis, and apoplexy in pituitary adenomas . Surg Neurol. 1982;18:181-189.Crossref 3. Muller-Jensen A, Ludecke D. Clinical aspects of spontaneous necrosis of pituitary tumors (pituitary apoplexy) . J Neurol. 1981;224:267-271.Crossref 4. Pelkonen R, Kuusisto A, Salmi J, et al. Pituitary function after pituitary apoplexy . Am J Med. 1978;65:773-777.Crossref 5. MacDonald TJ, Tolis G, MacGarry EE. Twenty two cases of pituitary apoplexy . Ann R Coll Phys Surg Can. 1975;8:19. 6. Post MJD, David NJ, Glaser JS, Safran A. Pituitary apoplexy: diagnosis by computed tomography . Radiology. 1980;134:665-670.Crossref 7. Findling JW, TyrrelJB, Aron DC, Fitzgerald PA, Wilson CB, Forsham PH. Silent pituitary apoplexy: subclinical infarction of an adrenocorticotropinproducing pituitary adenoma . J Clin Endocrinol Metab. 1981;52:95-97.Crossref 8. Wakai S, Fukushima T, Teramoto T, Sano K. Pituitary apoplexy: its incidence and clinical significance . J Neurosurg. 1981;55:187-193.Crossref 9. Reid RL, Quigley ME, Yen SSC. Pituitary apoplexy . Arch Neurol. 1985;42:712-719.Crossref 10. Cardoso ER, Peterson EW. Pituitary apoplexy: a review . Neurosurgery. 1984;14:363-372.Crossref 11. Donovan MJ, David NJ. Pituitary apoplexy: a radiographic-clinical correlation . Neuro-ophthalmology. 1982;7:177-221. 12. Rovit RL, Fein JM. Pituitary apoplexy: a review and reappraisal . J Neurosurg. 1972;37:280-288.Crossref 13. Sussman EB, Porro RS. Pituitary apoplexy: the role of atheromatous embolus . Stroke. 1974;5:318-323.Crossref 14. Kovacs K. Necrosis of anterior pituitary in human (parts I and II) . Neuroendocrinology. 1969;4:170-241.Crossref 15. Petersen P, Lindholm J. Pituitary apoplexy, the Houssay phenomenon and accelerated proliferative retinopathy . Am J Med. 1985;79:385-387.Crossref 16. Veldhuis JD, Hammond JM. Endocrine function after spontaneous infarction of the human pituitary: report, review and reappraisal . Endocr Rev. 1980;1:100-107.Crossref 17. Corkill G, Hanson FW, Sobel RA, Keller TM. Apoplexy in a prolactin microadenoma leading to remission of galactorrhea and amenorrhea . Surg Neurol. 1981;15:114-115.Crossref 18. Linquette M, Buvat J, Gauthier A, et al. Apoplexie hypophysaire révélatrice d'un adenome à cellules prolactiniques au cours d'une grossesse permise par la bromocriptine . Nouv Presse Med. 1977;6:3525-3531. 19. O'Donovan PA, O'Donovan PJ, Ritchie EH, Felly M, Jenkins DM. Apoplexy into a prolactin secreting macroadenoma during early pregnancy with successful outcome: case report . Br J Obstet Gynecol. 1986;93:389-391. 20. Weisberg LA. Pituitary apoplexy: association of degenerative change in pituitary adenoma with radiotherapy and detection by cerebral computed tomography . Am J Med. 1977;63:109-115.Crossref 21. Challa VR, Richards F, Davis CH. Intraventricular hemorrhage from pituitary apoplexy . Surg Neurol. 1981;16:360-361.Crossref 22. Cooper DM, Bazaral MG, Furlan AJ, et al. Pituitary apoplexy: a complication of cardiac surgery . Ann Thorac Surg. 1986;41:547-550.Crossref 23. Budabin M. Pituitary apoplexy associated with cardiac surgery . Am J Ophthalmol. 1984;98:291-296. 24. Tsementzis SA, Loisou LA. Pituitary apoplexy . Neurochirurgia. 1986;29:90-92. 25. Dawson BH, Kothandaram P. Acute massive infarction of pituitary adenomas . J Neurosurg. 1972;37:275-279.Crossref 26. Rouge PE, Gaio JM, Halimi S, de Rougemont J, Massot CH. Complications neurologiques aiguës des adénomes hypophysaires . Rev Med Interne. 1981;2:91-94.Crossref 27. Tsitsopoulos P, Andrews J, Harrison MJG. Pituitary apoplexy and haemorrhage into adenomas . Postgrad Med J. 1986;62:623-626.Crossref 28. Arafah BM, Taylor HC, Salazar R, Saadi H, Selman WR. Apoplexy of a pituitary adenoma after dynamic testing with gonadotropin-releasing hormone . Am J Med. 1989;87:103-105.Crossref 29. Bernstein M, Hegele RA, Gentili F, et al. Pituitary apoplexy associated with a triple bolus test: a case report . J Neurosurg. 1984;61:586-590.Crossref 30. Chapman AJ, Williams G, Hockley AD, London DR. Pituitary apoplexy after combined test of anterior pituitary function . BMJ. 1985;291:26.Crossref 31. Mikhailidis DP, Fonseca V, Dandona P. Pituitary apoplexy . BMJ. 1985;291:288-289.Crossref 32. Arisaka O, Hall R, Hugues IA. Spontaneous endocrine cure of gigantism due to pituitary apoplexy . BMJ. 1983;287:1007-1008.Crossref 33. Aumaitre O, Cellerier P, Abrieu V, et al. Syndrome de compression parasellaire brutale révelateur d'adénome hypophysaire, trois observations . Ann Med Interne. 1985;136:634-639. 34. Bjerre P, Lindholm J. Adult hydrocephalus and the empty sella . Acta Neurol Scand. 1984;70:201-203.Crossref 35. Cardoso ER, Peterson EW. Pituitary apoplexy and vasospasm . Surg Neurol. 1983;20:391-395.Crossref 36. Lloyd MH, Belchetz PE. The clinical features and management of pituitary apoplexy . Postgrad Med J. 1977;53:82-85.Crossref 37. Chen ST, Chen SD, Ryu SJ, Hsu TF, Heimburger RF. Pituitary apoplexy with intracerebral hemorrhage simulating rupture of an anterior cerebral artery aneurysm . Surg Neurol. 1988;29:322-325.Crossref 38. Reane JR. Pituitary apoplexy presenting with epistaxis . J Clin Neuro Ophthalmol. 1984;4:7-8. 39. Leech RW, Goodkin D, Obert G, Scheithauer B. Etiology of pituitary apoplexy: review and case presentation . Clin Neuropathol. 1987;6:7-11. 40. Marano SR, Sonntag VKH, Spetzler RF. Planum sphenoidal meningioma mimicking pituitary apoplexy: a case report . Neurosurgery. 1984;15:859-862.Crossref 41. Harris LS, Radisch DL. Panhypopituitarism in a young drug abuser . Forensic Sci Int. 1986;30:205-211.Crossref 42. Lacomis D, Johnson LN, Mamourian AC. Magnetic resonance imaging in pituitary apoplexy . Arch Ophthalmol. 1988;106:207-209.Crossref 43. Fitzpatrick D, Tolis G, McGarry EE, Taylor S. Pituitary apoplexy: the importance of skull roentgenograms and computerized tomography in diagnosis . JAMA. 1980;244:59-61.Crossref 44. Slavin M, Schoeppner G, Zito JL. Pituitary apoplexy . Arch Ophthalmol. 1988;106:269.Crossref 45. Mohanty S, Tandon PN, Banerjy AK, Prakash B. Haemorrhage into pituitary adenomas . J Neurol Neurosurg Psychiatry. 1977;40:987-991.Crossref 46. Epstein S, Pimstone BL, De Villiers JC, Jackson WPU. Pituitary apoplexy in five patients with pituitary tumors . BMJ. 1971;2:267-270.Crossref 47. Nichols BD, Romanchuk KG. Pituitary apoplexy presenting with light near dissociation of pupils . J Clin Neuro Ophthalmol. 1987;7:139-143.Crossref 48. Conomy JP, Ferguson JH, Brodkey JS, Mitsumoto H. Spontaneous infarction in pituitary tumors: neurologic and therapeutics aspects . Neurology. 1975;25:580-587.Crossref 49. D'Haens J, Baleriaux D, Mockel J, Flament-Durand J, Brotchi J. Apoplexie hypophysaire ischemique et accident vasculaire cerebral . Neurochirurgie. 1983;29:401-405. 50. Estopinan V, Varela C, Riobo P, Melian E, Qanchez-Franco F. Efectos de la apoplejia hipofisaria y de su tratamiento sobre el estudio hormonal: a proposito de 5 casos . Med Clin. 1987;89:470-472. 51. Taniyama M, Yonemaru M, Tanaka S, Maruyama T, Kataoka K, Matsuki S. Transient elevation of serum growth hormone level during pituitary apoplexy in acromegaly . Arch Intern Med. 1986;146:1001-1003.Crossref 52. Brooks MR, Baylis PH, Heath DA. Diabetes insipidus and panhypopituitarism after pituitary infarction in a case of acromegaly . BMJ. 1977;2:369.Crossref 53. Raskind R. Pituitary apoplexy . JAMA. 1981;246:835.Crossref 54. Cooperman D, Malarkey WB. Pituitary apoplexy . Heart Lung. 1978;7:450-454. 55. Fong LI P, Fabinyi GCA. Ophthalmic manifestations of pituitary apoplexy . Med J Aust. 1985;142:142-143. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Twelve Cases of Pituitary Apoplexy

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Publisher
American Medical Association
Copyright
Copyright © 1992 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1992.00400210115020
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Abstract

Abstract In 12 cases of pituitary apoplexy, a preexisting unsuspected adenoma was found. The initial manifestations were sudden onset of headache (12 patients), signs of meningeal irritation (10) with fever (four), altered consciousness (12), and ophthalmologic disturbances (eight). The diagnosis was retrospective in three cases. Radiologic investigations were always suggestive if carefully considered. The plain skull roentgenograms, in particular, showed an enlarged sella turcica in 11 cases. Three patients had prolactin adenomas, and nine had nonfunctional adenomas. Medical treatment was successful in only three patients; surgery was performed in 10 cases by means of a sublabial transseptal microsurgical approach. Postoperative neurologic complications were serious in two cases. Endocrine insufficiencies were common: eight cases of permanent panhypopituitarism, two cases of pluritropic anterior pituitary dysfunction, and three cases of persistent hyperprolactinemia. (Arch Intern Med. 1992;152:1893-1899) References 1. Ebersold MJ, Laws ER, Scheithauer BW, Randall RV. Pituitary apoplexy treated by transphenoidal surgery: a clinicopathological and immunocytological study . J Neurosurg. 1983;58:315-320.Crossref 2. Mohr G, Hardy J. Hemorrhage, necrosis, and apoplexy in pituitary adenomas . Surg Neurol. 1982;18:181-189.Crossref 3. Muller-Jensen A, Ludecke D. Clinical aspects of spontaneous necrosis of pituitary tumors (pituitary apoplexy) . J Neurol. 1981;224:267-271.Crossref 4. Pelkonen R, Kuusisto A, Salmi J, et al. Pituitary function after pituitary apoplexy . Am J Med. 1978;65:773-777.Crossref 5. MacDonald TJ, Tolis G, MacGarry EE. Twenty two cases of pituitary apoplexy . Ann R Coll Phys Surg Can. 1975;8:19. 6. Post MJD, David NJ, Glaser JS, Safran A. Pituitary apoplexy: diagnosis by computed tomography . Radiology. 1980;134:665-670.Crossref 7. Findling JW, TyrrelJB, Aron DC, Fitzgerald PA, Wilson CB, Forsham PH. Silent pituitary apoplexy: subclinical infarction of an adrenocorticotropinproducing pituitary adenoma . J Clin Endocrinol Metab. 1981;52:95-97.Crossref 8. Wakai S, Fukushima T, Teramoto T, Sano K. Pituitary apoplexy: its incidence and clinical significance . J Neurosurg. 1981;55:187-193.Crossref 9. Reid RL, Quigley ME, Yen SSC. Pituitary apoplexy . Arch Neurol. 1985;42:712-719.Crossref 10. Cardoso ER, Peterson EW. Pituitary apoplexy: a review . Neurosurgery. 1984;14:363-372.Crossref 11. Donovan MJ, David NJ. Pituitary apoplexy: a radiographic-clinical correlation . Neuro-ophthalmology. 1982;7:177-221. 12. Rovit RL, Fein JM. Pituitary apoplexy: a review and reappraisal . J Neurosurg. 1972;37:280-288.Crossref 13. Sussman EB, Porro RS. Pituitary apoplexy: the role of atheromatous embolus . Stroke. 1974;5:318-323.Crossref 14. Kovacs K. Necrosis of anterior pituitary in human (parts I and II) . Neuroendocrinology. 1969;4:170-241.Crossref 15. Petersen P, Lindholm J. Pituitary apoplexy, the Houssay phenomenon and accelerated proliferative retinopathy . Am J Med. 1985;79:385-387.Crossref 16. Veldhuis JD, Hammond JM. Endocrine function after spontaneous infarction of the human pituitary: report, review and reappraisal . Endocr Rev. 1980;1:100-107.Crossref 17. Corkill G, Hanson FW, Sobel RA, Keller TM. Apoplexy in a prolactin microadenoma leading to remission of galactorrhea and amenorrhea . Surg Neurol. 1981;15:114-115.Crossref 18. Linquette M, Buvat J, Gauthier A, et al. Apoplexie hypophysaire révélatrice d'un adenome à cellules prolactiniques au cours d'une grossesse permise par la bromocriptine . Nouv Presse Med. 1977;6:3525-3531. 19. O'Donovan PA, O'Donovan PJ, Ritchie EH, Felly M, Jenkins DM. Apoplexy into a prolactin secreting macroadenoma during early pregnancy with successful outcome: case report . Br J Obstet Gynecol. 1986;93:389-391. 20. Weisberg LA. Pituitary apoplexy: association of degenerative change in pituitary adenoma with radiotherapy and detection by cerebral computed tomography . Am J Med. 1977;63:109-115.Crossref 21. Challa VR, Richards F, Davis CH. Intraventricular hemorrhage from pituitary apoplexy . Surg Neurol. 1981;16:360-361.Crossref 22. Cooper DM, Bazaral MG, Furlan AJ, et al. Pituitary apoplexy: a complication of cardiac surgery . Ann Thorac Surg. 1986;41:547-550.Crossref 23. Budabin M. Pituitary apoplexy associated with cardiac surgery . Am J Ophthalmol. 1984;98:291-296. 24. Tsementzis SA, Loisou LA. Pituitary apoplexy . Neurochirurgia. 1986;29:90-92. 25. Dawson BH, Kothandaram P. Acute massive infarction of pituitary adenomas . J Neurosurg. 1972;37:275-279.Crossref 26. Rouge PE, Gaio JM, Halimi S, de Rougemont J, Massot CH. Complications neurologiques aiguës des adénomes hypophysaires . Rev Med Interne. 1981;2:91-94.Crossref 27. Tsitsopoulos P, Andrews J, Harrison MJG. Pituitary apoplexy and haemorrhage into adenomas . Postgrad Med J. 1986;62:623-626.Crossref 28. Arafah BM, Taylor HC, Salazar R, Saadi H, Selman WR. Apoplexy of a pituitary adenoma after dynamic testing with gonadotropin-releasing hormone . Am J Med. 1989;87:103-105.Crossref 29. Bernstein M, Hegele RA, Gentili F, et al. Pituitary apoplexy associated with a triple bolus test: a case report . J Neurosurg. 1984;61:586-590.Crossref 30. Chapman AJ, Williams G, Hockley AD, London DR. Pituitary apoplexy after combined test of anterior pituitary function . BMJ. 1985;291:26.Crossref 31. Mikhailidis DP, Fonseca V, Dandona P. Pituitary apoplexy . BMJ. 1985;291:288-289.Crossref 32. Arisaka O, Hall R, Hugues IA. Spontaneous endocrine cure of gigantism due to pituitary apoplexy . BMJ. 1983;287:1007-1008.Crossref 33. Aumaitre O, Cellerier P, Abrieu V, et al. Syndrome de compression parasellaire brutale révelateur d'adénome hypophysaire, trois observations . Ann Med Interne. 1985;136:634-639. 34. Bjerre P, Lindholm J. Adult hydrocephalus and the empty sella . Acta Neurol Scand. 1984;70:201-203.Crossref 35. Cardoso ER, Peterson EW. Pituitary apoplexy and vasospasm . Surg Neurol. 1983;20:391-395.Crossref 36. Lloyd MH, Belchetz PE. The clinical features and management of pituitary apoplexy . Postgrad Med J. 1977;53:82-85.Crossref 37. Chen ST, Chen SD, Ryu SJ, Hsu TF, Heimburger RF. Pituitary apoplexy with intracerebral hemorrhage simulating rupture of an anterior cerebral artery aneurysm . Surg Neurol. 1988;29:322-325.Crossref 38. Reane JR. Pituitary apoplexy presenting with epistaxis . J Clin Neuro Ophthalmol. 1984;4:7-8. 39. Leech RW, Goodkin D, Obert G, Scheithauer B. Etiology of pituitary apoplexy: review and case presentation . Clin Neuropathol. 1987;6:7-11. 40. Marano SR, Sonntag VKH, Spetzler RF. Planum sphenoidal meningioma mimicking pituitary apoplexy: a case report . Neurosurgery. 1984;15:859-862.Crossref 41. Harris LS, Radisch DL. Panhypopituitarism in a young drug abuser . Forensic Sci Int. 1986;30:205-211.Crossref 42. Lacomis D, Johnson LN, Mamourian AC. Magnetic resonance imaging in pituitary apoplexy . Arch Ophthalmol. 1988;106:207-209.Crossref 43. Fitzpatrick D, Tolis G, McGarry EE, Taylor S. Pituitary apoplexy: the importance of skull roentgenograms and computerized tomography in diagnosis . JAMA. 1980;244:59-61.Crossref 44. Slavin M, Schoeppner G, Zito JL. Pituitary apoplexy . Arch Ophthalmol. 1988;106:269.Crossref 45. Mohanty S, Tandon PN, Banerjy AK, Prakash B. Haemorrhage into pituitary adenomas . J Neurol Neurosurg Psychiatry. 1977;40:987-991.Crossref 46. Epstein S, Pimstone BL, De Villiers JC, Jackson WPU. Pituitary apoplexy in five patients with pituitary tumors . BMJ. 1971;2:267-270.Crossref 47. Nichols BD, Romanchuk KG. Pituitary apoplexy presenting with light near dissociation of pupils . J Clin Neuro Ophthalmol. 1987;7:139-143.Crossref 48. Conomy JP, Ferguson JH, Brodkey JS, Mitsumoto H. Spontaneous infarction in pituitary tumors: neurologic and therapeutics aspects . Neurology. 1975;25:580-587.Crossref 49. D'Haens J, Baleriaux D, Mockel J, Flament-Durand J, Brotchi J. Apoplexie hypophysaire ischemique et accident vasculaire cerebral . Neurochirurgie. 1983;29:401-405. 50. Estopinan V, Varela C, Riobo P, Melian E, Qanchez-Franco F. Efectos de la apoplejia hipofisaria y de su tratamiento sobre el estudio hormonal: a proposito de 5 casos . Med Clin. 1987;89:470-472. 51. Taniyama M, Yonemaru M, Tanaka S, Maruyama T, Kataoka K, Matsuki S. Transient elevation of serum growth hormone level during pituitary apoplexy in acromegaly . Arch Intern Med. 1986;146:1001-1003.Crossref 52. Brooks MR, Baylis PH, Heath DA. Diabetes insipidus and panhypopituitarism after pituitary infarction in a case of acromegaly . BMJ. 1977;2:369.Crossref 53. Raskind R. Pituitary apoplexy . JAMA. 1981;246:835.Crossref 54. Cooperman D, Malarkey WB. Pituitary apoplexy . Heart Lung. 1978;7:450-454. 55. Fong LI P, Fabinyi GCA. Ophthalmic manifestations of pituitary apoplexy . Med J Aust. 1985;142:142-143.

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Archives of Internal Medicine – American Medical Association

Published: Sep 1, 1992

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