Pituitary

, Volume 21, Issue 2, pp 138–144 | Cite as

Apoplexy in nonfunctioning pituitary adenomas

  • Luiz Eduardo Wildemberg
  • Andrea Glezer
  • Marcello D. Bronstein
  • Mônica R. Gadelha
Article
  • 227 Downloads

Abstract

Pituitary apoplexy is an uncommon event, occurring due to the infarction and/or haemorrhage usually of a previously unknown pituitary adenoma. It can occur in all adenoma subtypes but is more common in nonfunctioning pituitary adenomas. The physiopathology is not completely clear, and precipitating factors, such as major surgeries, anticoagulant use or pituitary dynamic tests, can be found in up to 40% of patients. The clinical presentation is characterized by a rapid onset with a headache as the main symptom, but visual disturbances can also be present as well as meningism and intracranial hypertension. The diagnosis is based on imaging evaluations, mainly using magnetic resonance imaging, which can show various patterns depending on the timeframe following the occurrence of the apoplectic event. Pituitary hormonal deficits are also common, and the evaluation of hormonal levels is mandatory. Pituitary apoplexy can be managed by surgery or conservative treatment, and a multidisciplinary team is essential for the decision-making process. The outcome is usually positive with both surgical and conservative approaches, but surveillance is needed due to the risk of re-bleeding or tumour recurrence.

Keywords

Nonfunctioning pituitary adenomas Apoplexy Pituitary apoplexy 

References

  1. 1.
    Briet C, Salenave S, Bonneville JF, Laws ER, Chanson P (2015) Pituitary Apoplexy Endocr Rev 36:622–645PubMedGoogle Scholar
  2. 2.
    Rajasekaran S, Vanderpump M, Baldeweg S, Drake W, Reddy N, Lanyon M, Markey A, Plant G, Powell M, Sinha S, Wass J (2011) UK guidelines for the management of pituitary apoplexy. Clin Endocrinol 74:9–20CrossRefGoogle Scholar
  3. 3.
    Fernandez A, Karavitaki N, Wass JA (2010) Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol 72:377–382CrossRefGoogle Scholar
  4. 4.
    Raappana A, Koivukangas J, Ebeling T, Pirilä T (2010) Incidence of pituitary adenomas in Northern Finland in 1992–2007. J Clin Endocrinol Metab 95:4268–4275CrossRefPubMedGoogle Scholar
  5. 5.
    Nomikos P, Ladar C, Fahlbusch R, Buchfelder M (2004) Impact of primary surgery on pituitary function in patients with non-functioning pituitary adenomas—a study on 721 patients. Acta Neurochir 146:27–35CrossRefPubMedGoogle Scholar
  6. 6.
    Vargas G, Gonzalez B, Ramirez C, Ferreira A, Espinosa E, Mendoza V, Guinto G, Lopez-Felix B, Zepeda E, Mercado M (2015) Clinical characteristics and treatment outcome of 485 patients with nonfunctioning pituitary macroadenomas. Int J Endocrinol 2015:756069CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Nielsen EH, Lindholm J, Bjerre P, Christiansen JS, Hagen C, Juul S, Jørgensen J, Kruse A, Laurberg P (2006) Frequent occurrence of pituitary apoplexy in patients with non-functioning pituitary adenoma. Clin Endocrinol 64:319–322CrossRefGoogle Scholar
  8. 8.
    Bills DC, Meyer FB, Laws ER, Davis DH, Ebersold MJ, Scheithauer BW, Ilstrup DM, Abboud CF (1993) A retrospective analysis of pituitary apoplexy. Neurosurgery 33:602–608 discussion 608–609CrossRefPubMedGoogle Scholar
  9. 9.
    Maccagnan P, Macedo CL, Kayath MJ, Nogueira RG, Abucham J (1995) Conservative management of pituitary apoplexy: a prospective study. J Clin Endocrinol Metab 80:2190–2197PubMedGoogle Scholar
  10. 10.
    Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass JA (1999) Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol 51:181–188CrossRefGoogle Scholar
  11. 11.
    Ayuk J, McGregor EJ, Mitchell RD, Gittoes NJ (2004) Acute management of pituitary apoplexy–surgery or conservative management? Clin Endocrinol 61:747–752CrossRefGoogle Scholar
  12. 12.
    Sibal L, Ball SG, Connolly V, James RA, Kane P, Kelly WF, Kendall-Taylor P, Mathias D, Perros P, Quinton R, Vaidya B (2004) Pituitary apoplexy: a review of clinical presentation, management and outcome in 45 cases. Pituitary 7:157–163CrossRefPubMedGoogle Scholar
  13. 13.
    Lubina A, Olchovsky D, Berezin M, Ram Z, Hadani M, Shimon I (2005) Management of pituitary apoplexy: clinical experience with 40 patients. Acta Neurochir 147:151–157 discussion 157CrossRefPubMedGoogle Scholar
  14. 14.
    Pal A, Capatina C, Tenreiro AP, Guardiola PD, Byrne JV, Cudlip S, Karavitaki N, Wass JA (2011) Pituitary apoplexy in non-functioning pituitary adenomas: long term follow up is important because of significant numbers of tumour recurrences. Clin Endocrinol 75:501–504CrossRefGoogle Scholar
  15. 15.
    Bujawansa S, Thondam SK, Steele C, Cuthbertson DJ, Gilkes CE, Noonan C, Bleaney CW, Macfarlane IA, Javadpour M, Daousi C (2014) Presentation, management and outcomes in acute pituitary apoplexy: a large single-centre experience from the United Kingdom. Clin Endocrinol 80:419–424CrossRefGoogle Scholar
  16. 16.
    Jho DH, Biller BM, Agarwalla PK, Swearingen B (2014) Pituitary apoplexy: large surgical series with grading system. World Neurosurg 82:781–790CrossRefPubMedGoogle Scholar
  17. 17.
    Vargas G, Gonzalez B, Guinto G, Mendoza V, López-Félix B, Zepeda E, Mercado M (2014) Pituitary apoplexy in nonfunctioning pituitary macroadenomas: a case-control study. Endocr Pract 20:1274–1280PubMedGoogle Scholar
  18. 18.
    Singh TD, Valizadeh N, Meyer FB, Atkinson JL, Erickson D, Rabinstein AA (2015) Management and outcomes of pituitary apoplexy. J Neurosurg 122:1450–1457CrossRefPubMedGoogle Scholar
  19. 19.
    Giritharan S, Gnanalingham K, Kearney T (2016) Pituitary apoplexy—bespoke patient management allows good clinical outcome. Clin Endocrinol 85:415–422CrossRefGoogle Scholar
  20. 20.
    Grzywotz A, Kleist B, Möller LC, Hans VH, Göricke S, Sure U, Müller O, Kreitschmann-Andermahr I (2017) Pituitary apoplexy—a single center retrospective study from the neurosurgical perspective and review of the literature. Clin Neurol Neurosurg 163:39–45CrossRefPubMedGoogle Scholar
  21. 21.
    Rutkowski MJ, Kunwar S, Blevins L, Aghi MK (2017) Surgical intervention for pituitary apoplexy: an analysis of functional outcomes. J Neurosurg.  https://doi.org/10.3171/2017.2.JNS1784 Google Scholar
  22. 22.
    Gondim JA, de Albuquerque LAF, Almeida JP, Bulcao T, Gomes E, Schops M, Vasconcelos R, da Paz F, Guimarães SB (2017) Endoscopic endonasal surgery for treatment of pituitary apoplexy: 16 years of experience in a specialized pituitary center: endoscopic surgery for pituitary apoplexy. World Neurosurg.  https://doi.org/10.1016/j.wneu.2017.08.131 PubMedGoogle Scholar
  23. 23.
    Dubuisson AS, Beckers A, Stevenaert A (2007) Classical pituitary tumour apoplexy: clinical features, management and outcomes in a series of 24 patients. Clin Neurol Neurosurg 109:63–70CrossRefPubMedGoogle Scholar
  24. 24.
    Fernández-Balsells MM, Murad MH, Barwise A, Gallegos-Orozco JF, Paul A, Lane MA, Lampropulos JF, Natividad I, Perestelo-Pérez L, Ponce de León-Lovatón, PG, Erwin PJ, Carey J, Montori VM (2011) Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis. J Clin Endocrinol Metab 96:905–912CrossRefPubMedGoogle Scholar
  25. 25.
    Sivakumar W, Chamoun R, Nguyen V, Couldwell WT (2011) Incidental pituitary adenomas. Neurosurg Focus 31:E18CrossRefPubMedGoogle Scholar
  26. 26.
    Oldfield EH, Merrill MJ (2015) Apoplexy of pituitary adenomas: the perfect storm. J Neurosurg 122:1444–1449CrossRefPubMedGoogle Scholar
  27. 27.
    Möller-Goede DL, Brändle M, Landau K, Bernays RL, Schmid C (2011) Pituitary apoplexy: re-evaluation of risk factors for bleeding into pituitary adenomas and impact on outcome. Eur J Endocrinol 164:37–43CrossRefPubMedGoogle Scholar
  28. 28.
    Zhu X, Wang Y, Zhao X, Jiang C, Zhang Q, Jiang W, Chen H, Shou X, Zhao Y, Li Y, Li S, Ye H (2015) Incidence of pituitary apoplexy and its risk factors in chinese people: a database study of patients with pituitary adenoma. PLoS ONE 10:e0139088CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Semple PL, Webb MK, de Villiers JC, Laws ER (2005) Pituitary apoplexy. Neurosurgery 56:65–72 (discussion 72–63)CrossRefPubMedGoogle Scholar
  30. 30.
    Briet C, Salenave S, Chanson P (2015) Pituitary apoplexy. Endocrinol Metab Clin North Am 44:199–209CrossRefPubMedGoogle Scholar
  31. 31.
    Biousse V, Newman NJ, Oyesiku NM (2001) Precipitating factors in pituitary apoplexy. J Neurol Neurosurg Psychiatry 71:542–545CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    Glezer A, Bronstein MD (2015) Pituitary apoplexy: pathophysiology, diagnosis and management. Arch Endocrinol Metab 59:259–264CrossRefPubMedGoogle Scholar
  33. 33.
    Morsi A, Jamal S, Silverberg JD (1996) Pituitary apoplexy after leuprolide administration for carcinoma of the prostate. Clin Endocrinol 44:121–124CrossRefGoogle Scholar
  34. 34.
    Wildemberg LE, Neto LV, Niemeyer P, Gasparetto EL, Chimelli L, Gadelha MR (2012) Association of dengue hemorrhagic fever with multiple risk factors for pituitary apoplexy. Endocr Pract 18:e97-e101CrossRefPubMedGoogle Scholar
  35. 35.
    Kumar V, Kataria R, Mehta VS (2011) Dengue hemorrhagic fever: a rare cause of pituitary tumor hemorrhage and reversible vision loss. Indian J Ophthalmol 59:311–312CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    Balarini Lima GA, Machado EeO, Dos Santos Silva CM, Filho PN, Gadelha MR (2008) Pituitary apoplexy during treatment of cystic macroprolactinomas with cabergoline. Pituitary 11:287–292CrossRefPubMedGoogle Scholar
  37. 37.
    Pivonello R, Matrone C, Filippella M, Cavallo LM, Di Somma C, Cappabianca P, Colao A, Annunziato L, Lombardi G (2004) Dopamine receptor expression and function in clinically nonfunctioning pituitary tumors: comparison with the effectiveness of cabergoline treatment. J Clin Endocrinol Metab 89:1674–1683CrossRefPubMedGoogle Scholar
  38. 38.
    Greenman Y, Cooper O, Yaish I, Robenshtok E, Sagiv N, Jonas-Kimchi T, Yuan X, Gertych A, Shimon I, Ram Z, Melmed S, Stern N (2016) Treatment of clinically nonfunctioning pituitary adenomas with dopamine agonists. Eur J Endocrinol 175:63–72CrossRefPubMedGoogle Scholar
  39. 39.
    Vieira Neto L, Wildemberg LE, Moraes AB, Colli LM, Kasuki L, Marques NV, Gasparetto EL, de Castro M, Takiya CM, Gadelha MR (2015) Dopamine receptor subtype 2 expression profile in nonfunctioning pituitary adenomas and in vivo response to cabergoline therapy. Clin Endocrinol 82:739–746CrossRefGoogle Scholar
  40. 40.
    Bonneville F, Cattin F, Marsot-Dupuch K, Dormont D, Bonneville JF, Chiras J (2006) T1 signal hyperintensity in the sellar region: spectrum of findings. Radiographics 26:93–113CrossRefPubMedGoogle Scholar
  41. 41.
    Boellis A, di Napoli A, Romano A, Bozzao A (2014) Pituitary apoplexy: an update on clinical and imaging features. Insights Imaging 5:753–762CrossRefPubMedPubMedCentralGoogle Scholar
  42. 42.
    Waqar M, McCreary R, Kearney T, Karabatsou K, Gnanalingham KK (2017) Sphenoid sinus mucosal thickening in the acute phase of pituitary apoplexy. Pituitary 20:441–449CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Semple PL, Jane JA, Lopes MB, Laws ER (2008) Pituitary apoplexy: correlation between magnetic resonance imaging and histopathological results. J Neurosurg 108:909–915CrossRefPubMedGoogle Scholar
  44. 44.
    Capatina C, Inder W, Karavitaki N, Wass JA (2015) Management of endocrine disease: pituitary tumour apoplexy. Eur J Endocrinol 172:R179-190CrossRefGoogle Scholar
  45. 45.
    Bi WL, Dunn IF, Laws ER (2015) Pituitary apoplexy. Endocrine 48:69–75CrossRefPubMedGoogle Scholar
  46. 46.
    Abdulbaki A, Kanaan I (2017) The impact of surgical timing on visual outcome in pituitary apoplexy: literature review and case illustration. Surg Neurol Int 8:16CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Tu M, Lu Q, Zhu P, Zheng W (2016) Surgical versus non-surgical treatment for pituitary apoplexy: a systematic review and meta-analysis. J Neurol Sci 370:258–262CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Luiz Eduardo Wildemberg
    • 1
    • 2
  • Andrea Glezer
    • 3
  • Marcello D. Bronstein
    • 3
  • Mônica R. Gadelha
    • 1
    • 2
  1. 1.Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga FilhoUniversidade Federal do Rio de JaneiroRio de JaneiroBrazil
  2. 2.Neuroendocrinology DivisionInstituto Estadual do Cérebro Paulo NiemeyerRio de JaneiroBrazil
  3. 3.Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das ClinicasUniversity of Sao Paulo Medical SchoolSão PauloBrazil

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