Skip to content
Licensed Unlicensed Requires Authentication Published by De Gruyter October 29, 2016

Complex effects of apoplexy secondary to pituitary adenoma

  • Rui-Cheng Zhang , Ying-Feng Mu , Jing Dong , Xiao-Qian Lin and De-Qin Geng EMAIL logo

Abstract

Pituitary adenoma apoplexy is a well-known clinical syndrome induced by insulin infusion, cardiac surgery, trauma, and hypothalamic releasing factors. Pituitary apoplexy can cause secondary cerebral infarct and internal carotid artery occlusion. With blockade of tumor perfusion, apoplexy triggers a sudden onset of headache, visual impairment, cranial nerve palsy, disturbances of consciousness, eyelid ptosis, and hemiparesis. However, pituitary adenoma cells with high metabolic demand cannot survive with deficient blood supply and glucose concentrations. Moreover, a number of case reports have shown that spontaneous remission of syndromes, such as acromegaly, may be caused by pituitary adenoma after apoplexy. Therefore, understanding mechanism that underlies the balance between pituitary adenoma apoplexy and subsequent spontaneous remission of syndromes may suggest new approaches for treatment of pituitary adenoma apoplexy.

Acknowledgments

We thank LetPub (www.letpub.com) for its linguistic assistance during the preparation of this manuscript.

  1. Conflict of interest statement: The authors declare that they have no conflict of interest.

References

Ahmed, S.K. and Semple, P.L. (2008). Cerebral ischaemia in pituitary apoplexy. Acta Neurochir. (Vienna) 150, 1193–1196.10.1007/s00701-008-0130-3Search in Google Scholar

Akutsu, H., Noguchi, S., Tsunoda, T., Sasaki, M., and Matsumura, A. (2004). Cerebral infarction following pituitary apoplexy – case report. Neurol. Med. Chir. (Tokyo) 44, 479–483.10.2176/nmc.44.479Search in Google Scholar

Arisaka, O., Hall, R., and Hughes, I.A. (1983). Spontaneous endocrine cure of gigantism due to pituitary apoplexy. Br. Med. J. (Clin. Res. Ed.) 287, 1007–1008.10.1136/bmj.287.6398.1007Search in Google Scholar

Banerjee, C., Snelling, B., Hanft, S., and Komotar, R.J. (2015). Bilateral cerebral infarction in the setting of pituitary apoplexy: a case presentation and literature review. Pituitary 18, 352–358.10.1007/s11102-014-0581-xSearch in Google Scholar

Boellis, A., di Napoli, A., Romano, A., and Bozzao, A. (2014). Pituitary apoplexy: an update on clinical and imaging features. Insights Imaging 5, 753–762.10.1007/s13244-014-0362-0Search in Google Scholar

Cardoso, E.R. and Peterson, E.W. (1984). Pituitary apoplexy: a review. Neurosurgery 14, 363–373.10.1227/00006123-198403000-00021Search in Google Scholar

Chentli, F., Bey, A., Belhimer F., and Azzoug, S. (2012). Spontaneous resolution of pituitary apoplexy in a giant boy under 10 years old. J Pediatr Endocrinol Metab. 25, 1177–1179.10.1515/jpem-2012-0256Search in Google Scholar

Chokyu, I., Tsuyuguchi, N., Goto, T., Chokyu, K., Chokyu, M., and Ohata, K. (2011). Pituitary apoplexy causing internal carotid artery occlusion – case report. Neurol. Med. Chir. (Tokyo) 51, 48–51.10.2176/nmc.51.48Search in Google Scholar

Cinar, N., Metin, Y., Dagdelen, S., Ziyal, M.I., Soylemezoglu, F., and Erbas, T. (2013). Spontaneous remission of acromegaly after infarctive apoplexy with a possible relation to MRI and diabetes mellitus. Neuro Endocrinol. Lett. 34, 339–342.10.1210/endo-meetings.2010.PART3.P6.P3-283Search in Google Scholar

Clark, J.D., Freer, C.E., and Wheatley, T. (1987). Pituitary apoplexy: an unusual cause of stroke. Clin. Radiol. 38, 75–77.10.1016/S0009-9260(87)80414-2Search in Google Scholar

Fraser, L.A., Lee, D., Cooper, P., and Van Uum, S. (2009). Remission of acromegaly after pituitary apoplexy: case report and review of literature. Endocr. Pract. 15, 725–731.10.4158/EP09126.CRRSearch in Google Scholar

Glezer, A. and Bronstein, M.D. (2015). Pituitary apoplexy: pathophysiology, diagnosis and management. Arch. Endocrinol. Metab. 59, 259–264.10.1590/2359-3997000000047Search in Google Scholar

Jackson, D.L., and Van Gompel, J.J. (2015). Rapid pituitary apoplexy regression: what is the time course of clot resolution? Case Rep Radiol. 2015, 268974.10.1155/2015/268974Search in Google Scholar

Jeon, B.C., Park, Y.S., Oh, H.S., Kim, Y.S., and Chun, B.K. (2007). Pituitary apoplexy complicated by chemical meningitis and cerebral infarction. J. Korean Med. Sci. 22, 1085–1089.10.3346/jkms.2007.22.6.1085Search in Google Scholar

Johnston, P.C., Hamrahian, A.H., Weil, R.J., and Kennedy, L. (2015). Pituitary tumor apoplexy. J. Clin. Neurosci. 22, 939–944.10.1016/j.jocn.2014.11.023Search in Google Scholar

Kachhara, R., Nair, S., and Gupta, A.K. (2000). Spontaneous resolution of a non-functioning pituitary adenoma following an apoplexy. Neurol. India 48, 294–296.Search in Google Scholar

Lath, R. and Rajshekhar, V. (2001). Massive cerebral infarction as a feature of pituitary apoplexy. Neurol. India 49, 191–193.Search in Google Scholar

Liu, S., Wang, X., Liu, Y.H., and Mao, Q. (2012). Spontaneous disappearance of the pituitary macroadenoma after apoplexy: a case report and review of the literature. Neurol. India 60, 530–532.10.4103/0028-3886.103211Search in Google Scholar

Lomban, E., Bonneville, F., Karachi, C., Abdennour, L., Dormont, D., and Chiras, J. (2006). Massive stroke in a patient with pituitary apoplexy, cervical carotid artery stenosis and hypotension. J. Neuroradiol. 33, 259–262.10.1016/S0150-9861(06)77272-8Search in Google Scholar

Machado, M.C., Gadelha, P.S., Bronstein, M.D., and Fragoso, M.C. (2013). Spontaneous remission of hypercortisolism presumed due to asymptomatic tumor apoplexy in ACTH-producing pituitary macroadenoma. Arq. Braz. Endocrinol. Metabol. 57, 486–489.10.1590/S0004-27302013000600012Search in Google Scholar

Maltby, V.E., Crock, P.A., and Ludecke, D.K. (2014). A rare case of pituitary infarction leading to spontaneous tumour resolution and CSF-sella syndrome in an 11-year-old girl and a review of the paediatric literature. J Pediatr Endocrinol Metab. 27, 939–946.10.1515/jpem-2014-0143Search in Google Scholar PubMed

Mathur, D., Lim, L.F., Mathur, M., and Sng, B.L. (2014). Pituitary apoplexy with reversible cerebral vasoconstrictive syndrome after spinal anaesthesia for emergency caesarean section: an uncommon cause for postpartum headache. Anaesth. Intensive Care 42, 99–105.10.1177/0310057X1404200118Search in Google Scholar PubMed

Mukherjee, S., Majumder, A., Dattamunshi, A.K., and Maji, D. (1995). Ischaemic stroke leading to left hemiparesis and autohypophysectomy in a case of pituitary macroadenoma. J. Assoc. Physicians India 43, 801–802.Search in Google Scholar

Murad-Kejbou, S. and Eggenberger, E. (2009). Pituitary apoplexy: evaluation, management, and prognosis. Curr. Opin. Ophthalmol. 20, 456–461.10.1097/ICU.0b013e3283319061Search in Google Scholar PubMed

Nishioka, H., Haraoka, J., and Miki, T. (2005). Spontaneous remission of functioning pituitary adenomas without hypopituitarism following infarctive apoplexy: two case reports. Endocr J. 52, 117–123.10.1507/endocrj.52.117Search in Google Scholar PubMed

Oldfield, E.H. and Merrill, M.J. (2015). Apoplexy of pituitary adenomas: the perfect storm. J. Neurosurg. 122, 1444–1449.10.3171/2014.10.JNS141720Search in Google Scholar PubMed

Pant, B., Arita, K., Kurisu, K., Tominaga, A., Eguchi K., and Uozumi, T. (1997). Incidence of intracranial aneurysm associated with pituitary adenoma. Neurosurg Rev. 20, 13–17.10.1007/BF01390519Search in Google Scholar PubMed

Pozzati, E., Frank, G., Nasi, M.T., and Giuliani, G. (1987). Pituitary apoplexy, bilateral carotid vasospasm, and cerebral infarction in a 15-year-old boy. Neurosurgery 20, 56–59.10.1227/00006123-198701000-00015Search in Google Scholar PubMed

Radhiana, H., Syazarina, S.O., Shahizon Azura, A.M., and Azizi, A.B. (2013). Pituitary apoplexy: a rare cause of middle cerebral artery infarction. Med. J. Malaysia 68, 264–266.Search in Google Scholar

Rebeiz, T., Cueva, W., and Ardelt, A. (2014). Unusual case of bilateral caudate infarcts following pituitary apoplexy. JAMA Neurol. 71, 226–227.10.1001/jamaneurol.2013.4528Search in Google Scholar PubMed

Rodier, G., Mootien, Y., Battaglia, F., Martinet, O., and Cohen, E. (2003). Bilateral stroke secondary to pituitary apoplexy. J. Neurol. 250, 494–495.10.1007/s00415-003-1008-1Search in Google Scholar PubMed

Roerink, S.H., van Lindert, E.J., and van de Ven, A.C. (2015). Spontaneous remission of acromegaly and Cushing’s disease following pituitary apoplexy: two case reports. Neth. J. Med. 73, 242–246.Search in Google Scholar

Rosenbaum, T.J., Houser, O.W., and Laws, E.R. (1977). Pituitary apoplexy producing internal carotid artery occlusion. Case report. J. Neurosurg. 47, 599–604.10.3171/jns.1977.47.4.0599Search in Google Scholar PubMed

Rovit, R.L. and Fein, J.M. (1972). Pituitary apoplexy: a review and reappraisal. J. Neurosurg. 37, 280–288.10.3171/jns.1972.37.3.0280Search in Google Scholar PubMed

Schatz, N.J., Job, O.M., and Glaser, J.S. (2000). Spontaneous resolution of pituitary adenoma after apoplexy. J Neuroophthalmol. 20, 42–44.10.1097/00041327-200020010-00014Search in Google Scholar PubMed

Semple, P.L., Webb, M.K., de Villiers, J.C., and Laws, E.R., Jr. (2005). Pituitary apoplexy. Neurosurgery 56, 65–72.10.1227/01.NEU.0000144840.55247.38Search in Google Scholar

Tamasawa, N., Kurahashi, K., Baba, T., Hishita, T., Murabayashi, S., Kashiwamura, H., and Takebe, K. (1988). Spontaneous remission of acromegaly after pituitary apoplexy following head trauma. J. Endocrinol. Invest. 11, 429–432.10.1007/BF03349076Search in Google Scholar PubMed

Thomas, N., Simon, R., Chacko, G., Chacko, A.G., Chandy, M.J., and Seshadri, M.S. (1999). Regression of acromegaly following pituitary apoplexy. Neurol. India 47, 161–162.Search in Google Scholar

Wang, X.L., Dou, J.T., Lu, Z.H., Zhong, W.W., Ba, J.M., Jin, D., Lu, J.M., Pan, C.Y., and Mu, Y.M. (2011). Spontaneous remission of acromegaly or gigantism due to subclinical apoplexy of pituitary growth hormone adenoma. Chin. Med. J. (Engl.) 124, 3820–3823.Search in Google Scholar

Wichers, M., Kristof, R.A., Springer, W., Schramm, J., and Klingmuller, D. (1997). Pituitary apoplexy with spontaneous cure of acromegaly and its possible relation to Gd-DTPA-administration. Acta Neurochir. (Vienna) 139, 992–994.10.1007/BF01411312Search in Google Scholar PubMed

Xu, K., Yuan, Y., Zhou, J., and Yu, J. (2015). Pituitary adenoma apoplexy caused by rupture of an anterior communicating artery aneurysm: case report and literature review. World J. Surg. Oncol. 13, 228.10.1186/s12957-015-0653-zSearch in Google Scholar PubMed PubMed Central

Zhang, C., Feng, F., Zhu, Y., Wang, R., and Xing, B. (2014). Cerebral infarction caused by pituitary apoplexy: case report and review of literature. Turk. Neurosurg. 24, 782–787.10.5137/1019-5149.JTN.9237-13.0Search in Google Scholar PubMed

Zieliński, G., Witek, P., Koziarski, A., and Podgorski, J. (2013). Spontaneous regression of non-functioning pituitary adenoma due to pituitary apoplexy following anticoagulation treatment – a case report and review of the literature. Endokrynol. Pol. 64, 54–58.Search in Google Scholar

Received: 2016-3-22
Accepted: 2016-7-15
Published Online: 2016-10-29
Published in Print: 2017-1-1

©2017 Walter de Gruyter GmbH, Berlin/Boston

Downloaded on 29.3.2024 from https://www.degruyter.com/document/doi/10.1515/revneuro-2016-0013/html
Scroll to top button