Pituitary Apoplexy Kyla Lokitz Morning Report 7/18/05
Pituitary Apoplexy <ul><li>A clinical syndrome resulting from acute hemorrhage or infarction of the pituitary gland charac...
Epidemiology <ul><li>Incidence found to be 0.6-9.0 % in series of surgically treated adenomas in patients with pituitary a...
Predisposing Factors: <ul><li>Arterial hypertension </li></ul><ul><li>Sudden head trauma </li></ul><ul><li>Cardiac surgery...
Pathophysiology <ul><li>With rapid growth, tumor outgrows blood supply </li></ul><ul><li>Compression of the infundibular a...
Diagnosis <ul><li>Laboratory Data: </li></ul><ul><ul><li>Prolactin, TSH, FT4, FT3, Cortisol, LH, FSH, Testosterone, Estrog...
Treatment <ul><li>Careful monitoring of fluid and electrolyte balance  </li></ul><ul><li>Replacement of deficient hormone,...
Surgical Treatment Indicated with: <ul><li>Diminished level of consciousness </li></ul><ul><li>Hypothalmic disturbances </...
Conservative Therapy <ul><li>Favored in patients without or with mild neuro-opthalmic signs. </li></ul><ul><ul><li>Retrosp...
References <ul><li>Ayuck, J.  et al . Acute management of pituitary apoplexy – surgery or conservative management?  Clinic...
Upcoming SlideShare
Loading in …5
×

Pituitary Apoplexy 2005-6

1,085 views

Published on

Published in: Health & Medicine
  • Be the first to comment

Pituitary Apoplexy 2005-6

  1. 7. Pituitary Apoplexy Kyla Lokitz Morning Report 7/18/05
  2. 8. Pituitary Apoplexy <ul><li>A clinical syndrome resulting from acute hemorrhage or infarction of the pituitary gland characterized by the onset of: </li></ul><ul><ul><li>Headache </li></ul></ul><ul><ul><li>Vomiting </li></ul></ul><ul><ul><li>Visual Disturbances </li></ul></ul><ul><ul><li>Opthalmoplegia – CN III most common </li></ul></ul><ul><ul><li>Meningismus </li></ul></ul><ul><ul><li>Fever </li></ul></ul><ul><ul><li>Decreased Consciousness </li></ul></ul><ul><ul><li>Death </li></ul></ul>
  3. 9. Epidemiology <ul><li>Incidence found to be 0.6-9.0 % in series of surgically treated adenomas in patients with pituitary apoplexy (Semple et al . 2005). </li></ul><ul><li>Pituitary hemorrhage observed in 25% of surgically removed adenomas; however, these patients were without clinical symptoms (Subclinical Pituitary Apoplexy) (Sibal et al . 2005). </li></ul><ul><li>Hemorrhage and infarction with similar clinical presentation described in nontumerous pituitary glands. Also seen in other pituitary tumors such as craniopharyngiomas and lymphocytic hypophysitis. </li></ul><ul><li>Cases reported in patients in first through ninth decade although pediatric cases rare. </li></ul><ul><li>Series suggest apoplexy occurs more frequently in males (Lubina et al . 2005). </li></ul>
  4. 10. Predisposing Factors: <ul><li>Arterial hypertension </li></ul><ul><li>Sudden head trauma </li></ul><ul><li>Cardiac surgery </li></ul><ul><li>Transient elevation of intracranial pressure </li></ul><ul><li>Diabetes </li></ul><ul><li>Acromegaly </li></ul><ul><li>Cushing’s Syndrome </li></ul><ul><li>Estrogens </li></ul><ul><li>Anticoagulation </li></ul><ul><li>Bromocriptine </li></ul><ul><li>Dynamic pituitary function tests </li></ul><ul><li>GnRH analogues </li></ul><ul><li>Radiotherapy </li></ul>
  5. 11. Pathophysiology <ul><li>With rapid growth, tumor outgrows blood supply </li></ul><ul><li>Compression of the infundibular and superior hypophyseal vessels against the diaphragma sellae </li></ul><ul><li>Ischemia of the normal pituitary gland </li></ul><ul><li>Intrinsic vasculopathy of pituitary tumors </li></ul>
  6. 12. Diagnosis <ul><li>Laboratory Data: </li></ul><ul><ul><li>Prolactin, TSH, FT4, FT3, Cortisol, LH, FSH, Testosterone, Estrogen, GH, IGF1 </li></ul></ul><ul><ul><li>Electrolytes, CBC (patients often present with hyponatremia and leukocytosis) </li></ul></ul><ul><ul><li>CSF-rbcs, xanthachromia, pleocytosis, increased protein </li></ul></ul><ul><li>Imaging </li></ul><ul><ul><li>X-ray may demonstrate enlarged sella </li></ul></ul><ul><ul><li>CT will demonstrate pituitary mass but not sensitive in demonstrating hemorrhage or infarction (i.e. CT diagnostic in only 28% of cases, defined sellar mass in 72% of cases) (Sibal et al . 04) </li></ul></ul><ul><ul><li>MRI is the radiologic mode of choice (i.e. confirmed diagnosis in >90% of cases) (Sibal et al . 04) </li></ul></ul>
  7. 13. Treatment <ul><li>Careful monitoring of fluid and electrolyte balance </li></ul><ul><li>Replacement of deficient hormone, especially corticosteriods </li></ul><ul><li>Pituitary surgery </li></ul><ul><li>Long term monitoring for hypopituitarism and recurrence of pituitary adenomas </li></ul>
  8. 14. Surgical Treatment Indicated with: <ul><li>Diminished level of consciousness </li></ul><ul><li>Hypothalmic disturbances </li></ul><ul><li>Visual impairment </li></ul><ul><ul><li>Some disagreement in literature about timing of surgery; question of improved outcome (in visual field and visual acuity) if operation occurs within 8 days of onset of symptoms (Randeva et al . 1999); other studies demonstrate satisfactory recovery of vision with late surgery (Ayuck et al . 2004, Sibal et al. 2005). </li></ul></ul>
  9. 15. Conservative Therapy <ul><li>Favored in patients without or with mild neuro-opthalmic signs. </li></ul><ul><ul><li>Retrospective studies have shown spontaneous improvement in neuro-opthalmic symptoms with conservative management (Sibal et al . 2005) </li></ul></ul>
  10. 16. References <ul><li>Ayuck, J. et al . Acute management of pituitary apoplexy – surgery or conservative management? Clinical Endocrinology 2004, 61: 747-752. </li></ul><ul><li>Levy, A. et al . Pituitary Disease: Presentation, Diagnosis, and Management. J Neurol Neurosur Psychiatry 2004, 75:1147-1152. </li></ul><ul><li>Lubina A. et al . Management of pituitary apoplexy: clinical experience with 40 patients. Acta Neurochirugica 2005, 147:151-157. </li></ul><ul><li>Ma, R. et al . Fever, headache, and a stiff neck. The Lancet 2004, 363: 1868. </li></ul><ul><li>Randeva, H. et al . Classical pituitary apoplexy: clinical features, management, and outcome. Clinical Endocrinology 1999, 51:181-188. </li></ul><ul><li>Semple, P. et al . Pituitary apoplexy. Neurosurgery 2005, 56: 65-73. </li></ul>

×