RESUMO
Pituitary apoplexy is a rare but potentially life-threatening complication of androgen deprivation therapy for prostate cancer. We present a case of a 70-year-old African American male with prostate cancer who developed symptoms of pituitary apoplexy, including hot flashes, nausea, vomiting, and cranial nerve III palsy, following the initiation of leuprolide therapy. Imaging revealed a pituitary adenoma with hemorrhage, and prompt multidisciplinary management was initiated. The patient was managed conservatively with improvement in symptoms. This case highlights the importance of recognizing the potential for pituitary apoplexy in patients receiving GnRH agonist therapy. We discuss the clinical presentation of GnRH agonist induced pituitary apoplexy, emphasizing that clinicians should maintain a high index of suspicion and promptly investigate any new neuro- ophthalmic symptoms in this group of patients. Ultimately, prompt diagnosis and treatment are crucial to mitigate the severity of this complication in patients with prostate cancer undergoing androgen deprivation therapy.
Assuntos
Apoplexia Hipofisária , Neoplasias da Próstata , Humanos , Masculino , Idoso , Neoplasias da Próstata/tratamento farmacológico , Leuprolida/efeitos adversos , Apoplexia Hipofisária/induzido quimicamente , Apoplexia Hipofisária/diagnóstico , Apoplexia Hipofisária/tratamento farmacológico , Antineoplásicos Hormonais/efeitos adversos , Antagonistas de Androgênios/efeitos adversos , Androgênios/uso terapêuticoRESUMO
PURPOSE: Pituitary apoplexy can be a life threatening and vision compromising event. Antiplatelet and anticoagulation use has been reported as a contributing factor in pituitary apoplexy (PA). Utilizing one of the largest cohorts in the literature, this study aims to determine the risk of PA in patients on antiplatelet/anticoagulation (AP/AC) therapy. METHODS: A single center, retrospective study was conducted on 342 pituitary adenoma patients, of which 77 patients presented with PA (23%). Several potential risk factors for PA were assessed, including: patient demographics, tumor characteristics, pre-operative hormone replacement, neurologic deficits, coagulation studies, platelet count, and AP/AC therapy. RESULTS: Comparing patients with and without apoplexy, there was no significant difference in the proportion of patients taking aspirin (45 no apoplexy vs. 10 apoplexy; p = 0.5), clopidogrel (10 no apoplexy vs. 4 apoplexy; p = 0.5), and anticoagulation (7 no apoplexy vs. 3 apoplexy; p = 0.7). However, male sex (p-value < 0.001) was a predictor for apoplexy while pre-operative hormone treatment was a protective factor from apoplexy (p-value < 0.001). A non-clinical difference in INR was also noted as a predictor for apoplexy (no apoplexy: 1.01 ± 0.09, apoplexy: 1.07 ± 0.15; p < 0.001). CONCLUSIONS: Although pituitary tumors have a high risk for spontaneous hemorrhage, the use of aspirin is not a risk for hemorrhage. Our study did not find an increased risk of apoplexy with clopidogrel or anticoagulation, but further investigation is needed with a larger cohort. Confirming other reports, male sex is associated with an increased risk for PA.
Assuntos
Adenoma , Apoplexia Hipofisária , Neoplasias Hipofisárias , Acidente Vascular Cerebral , Humanos , Masculino , Neoplasias Hipofisárias/cirurgia , Apoplexia Hipofisária/tratamento farmacológico , Apoplexia Hipofisária/etiologia , Estudos Retrospectivos , Clopidogrel/uso terapêutico , Adenoma/cirurgia , Hemorragia , Anticoagulantes/efeitos adversos , HormôniosRESUMO
BACKGROUND: Primary central nervous system lymphoma (PCNSL) is a rare but well-known extra-nodal lymphoma, which usually presents with non-Hodgkin B-cell lymphomas. PCNSL is generally located around the ventricle and is often detected as multiple lesions. It is rarely seen in the area of the hypothalamus. CASE PRESENTATION: We report the case of a 48-year-old Caucasian woman with progressive short-term memory deterioration, headache, mental confusion, diabetes insipidus (DI) and hypopituitarism. Early findings were suggestive of a pituitary apoplexy. The results of tests performed during the initial admission at the tertiary health center revealed hypernatremia, hypopituitarism and DI. Intravenous hydrocortisone treatment was initiated for the secondary adrenal insufficiency, and 75 mcg/day of levothyroxine was started for the secondary hypothyroidism on the fourth day following hydrocortisone treatment. A daily dose of 120 mg desmopressin melt tablet was started twice a day for polyuria/polydipsia after the patient's volume status was balanced. A brain magnetic resonance imaging scan revealed a mass lesion in the hypothalamic area, which was surrounded by marked edema. Anti-edema treatment was initially started considering the suggestion by our neurosurgery team. The patient's clinical and laboratory findings improved after the initiation of the anti-edema therapy. Afterwards, a biopsy was performed, which diagnosed a malignant diffuse large B-cell lymphoma. Subsequently, intravenous high-dose methotrexate-based therapy was started; however, after the second cycle of chemotherapy, the patient died due to sepsis. CONCLUSION: In this report, we present a case of hypopituitarism that developed due to the mass effect of hypothalamic lymphoma with clinical findings of pituitary apoplexy. Intracranial masses may cause obvious endocrinological findings related to hypopituitarism, while vague findings may also be observed due to partial failure. Therefore, it is important to perform a comprehensive endocrinological examination at the time of diagnosis in patients with intracranial masses.
Assuntos
Neoplasias do Sistema Nervoso Central , Hipopituitarismo , Linfoma , Apoplexia Hipofisária , Feminino , Humanos , Hipotálamo , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Apoplexia Hipofisária/diagnóstico , Apoplexia Hipofisária/tratamento farmacológicoRESUMO
CONTEXT: Prolactinomas frequently cause amenorrhoea, galactorrhoea and infertility and require dopamine agonist (DA) treatment to normalize prolactin levels and hence, restore ovulation. The vast majority of female patients harbour microprolactinomas in whom DA treatment is usually discontinued at the time of pregnancy diagnosis and surveillance is generally limited as the symptomatic growth is considered very rare. CASE DESCRIPTIONS: We report five cases of women harbouring a microprolactinoma in whom symptomatic pituitary apoplexy occurred during pregnancy. Only one necessitated surgery during pregnancy, while the others were treated conservatively by reintroducing DAs in three. A systematic literature review found reports of four additional cases among 20 cases of prolactinomas (both macro- and micro-prolactinomas) complicated by apoplexy during pregnancy. CONCLUSION: During pregnancy, pituitary apoplexy may occur in pre-existing microprolactinomas, causing tumour enlargement and headache, which may be self-limiting but may require intervention by re-initation of dopamine agonists or surgery. Our literature review confirms that this clinical event is rare; nevertheless, physicians managing pregnant patients with microprolactinomas must be aware that symptomatic pituitary apoplexy may incidentally occur in all trimesters of pregnancy and require prompt radiological, endocrine and ophthalmological assessment and treatment.
Assuntos
Agonistas de Dopamina/uso terapêutico , Apoplexia Hipofisária/tratamento farmacológico , Neoplasias Hipofisárias/tratamento farmacológico , Complicações Neoplásicas na Gravidez/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Adulto , Bromocriptina/uso terapêutico , Cabergolina/uso terapêutico , Feminino , Humanos , Apoplexia Hipofisária/etiologia , Apoplexia Hipofisária/cirurgia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/patologia , Neoplasias Hipofisárias/cirurgia , Gravidez , Complicações na Gravidez/tratamento farmacológico , Complicações na Gravidez/etiologia , Complicações na Gravidez/cirurgia , Complicações Neoplásicas na Gravidez/cirurgia , Prolactinoma/complicações , Prolactinoma/patologia , Prolactinoma/cirurgia , Carga Tumoral , Adulto JovemRESUMO
COVID-19 is a respiratory virus, which has affected various organ systems as well. Here we report a neuro-ophthalmic presentation of pituitary apoplexy under the setting of COVID-19 infection in a middle-aged man who presented to ophthalmic emergency with sudden bilateral loss of vision along with a history of fever past 10 days. There was sluggishly reacting pupils and RT-PCR for COVID was positive. Imaging pointed the diagnosis as pituitary macroadenoma with apopexy. In view of pandemic situation, patient was given symptomatic treatment as per the protocols and stabilized. Vision also showed improvement to some extent and the patient is awaiting neurosurgery.
Assuntos
Adenoma/diagnóstico , COVID-19/diagnóstico , Infecções Oculares Virais/diagnóstico , Apoplexia Hipofisária/diagnóstico , Neoplasias Hipofisárias/diagnóstico , SARS-CoV-2 , Adenoma/tratamento farmacológico , Adenoma/virologia , Infecções Oculares Virais/tratamento farmacológico , Infecções Oculares Virais/virologia , Glucocorticoides/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Masculino , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Apoplexia Hipofisária/tratamento farmacológico , Apoplexia Hipofisária/virologia , Neoplasias Hipofisárias/tratamento farmacológico , Neoplasias Hipofisárias/virologia , Tratamento Farmacológico da COVID-19RESUMO
RATIONALE: Pituitary tumor apoplexy (PTA) is a rare clinical syndrome which requires urgent diagnosis and treatment due to its life-threatening consequences. Management of undiagnosed pituitary tumor before pregnancy is a problem during pregnancy. PATIENT CONCERNS: We reported a case with PTA which was not diagnosed before pregnancy presenting with vomiting associated with hyponatremia during the third trimester. After supplying the sodium the patient presented with dysarthria and hemiplegia. DIAGNOSES: MRI examination showed PTA accompanied with extrapontine myelinolysis (EPM). INTERVENTIONS: The patient was given hydrocortisone according to the symptoms gradually to taper off dose, at the same times oral levothyroxine therapy (25µg/day) was given. OUTCOMES: The patient delivered a healthy baby via cesarean section at hospital at 38â+â1âweek of gestation. We performed MRI examination regularly and the tumor regressed significantly 8âmonths postpartum. LESSONS: We reported a case as PTA associated with EPM. Headache during pregnancy is often nonspecific, so careful medical history inquiry is very important.
Assuntos
Mielinólise Central da Ponte/diagnóstico , Apoplexia Hipofisária/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Complicações Neoplásicas na Gravidez/diagnóstico , Cesárea , Quimioterapia Combinada , Disartria/etiologia , Feminino , Cefaleia/tratamento farmacológico , Cefaleia/etiologia , Hemiplegia/tratamento farmacológico , Hemiplegia/etiologia , Humanos , Hidrocortisona/administração & dosagem , Hiponatremia/diagnóstico , Hiponatremia/tratamento farmacológico , Hiponatremia/etiologia , Imageamento por Ressonância Magnética , Mielinólise Central da Ponte/tratamento farmacológico , Mielinólise Central da Ponte/etiologia , Apoplexia Hipofisária/sangue , Apoplexia Hipofisária/tratamento farmacológico , Apoplexia Hipofisária/etiologia , Hipófise/diagnóstico por imagem , Neoplasias Hipofisárias/sangue , Neoplasias Hipofisárias/complicações , Gravidez , Terceiro Trimestre da Gravidez , Sódio/administração & dosagem , Tiroxina/administração & dosagem , Resultado do Tratamento , Vômito/tratamento farmacológico , Vômito/etiologia , Adulto JovemRESUMO
BACKGROUND: Takotsubo cardiomyopathy (TTC) has been widely recognized in recent decades and is triggered by either physical or psychological stressors. CASE PRESENTATION: A 70-year-old woman presented to the Emergency Department due to confusion, hypotension, fever, chills, and cough. She had a one-year history of diabetes insipidus. Pituitary function examination at admission revealed decreased thyroid, sex and adrenal hormones. Pituitary MRI displayed findings suggestive of nonhemorrhagic pituitary apoplexy. Electrocardiogram (ECG) revealed T-wave inversion and extended QT interval. Transthoracic echocardiogram (TTE) showed left ventricular apical dysplasia and ballooning, accompanied by reduced left ventricular ejection fraction. Coronary angiography (CAG) revealed no obvious coronary arterial stenosis. The left ventriculogram demonstrated an octopus clathrate appearance. Most ECG and TTE changes recovered 10 days later. CONCLUSIONS: To the best of our knowledge, this is the first report of newly diagnosed TTC associated with pituitary apoplexy.
Assuntos
Apoplexia Hipofisária/complicações , Cardiomiopatia de Takotsubo/etiologia , Hormônio Adrenocorticotrópico/uso terapêutico , Idoso , Fármacos Cardiovasculares/uso terapêutico , Feminino , Terapia de Reposição Hormonal , Humanos , Apoplexia Hipofisária/diagnóstico por imagem , Apoplexia Hipofisária/tratamento farmacológico , Apoplexia Hipofisária/fisiopatologia , Cardiomiopatia de Takotsubo/diagnóstico por imagem , Cardiomiopatia de Takotsubo/tratamento farmacológico , Cardiomiopatia de Takotsubo/fisiopatologia , Tiroxina/uso terapêutico , Resultado do Tratamento , Função Ventricular EsquerdaRESUMO
RATIONALE: Pituitary apoplexy (PA) and posterior reversible encephalopathy syndrome (PRES) are rare neurologic diseases that show acute neuro-ophthalmologic symptoms such as headache, decreased visual acuity, and altered consciousness. These diseases are rarely found in patients with end-stage renal disease (ESRD) on hemodialysis, and simultaneous occurrence of these 2 diseases has not been reported. PATIENT CONCERNS: The patient was a 75-year-old man with a history of hypertension, diabetes mellitus, and non-functioning pituitary macroadenoma. He had been receiving hemodialysis for ESRD for 3 months before his presentation to the emergency room. The patient complained of headache, vomiting, and dizziness that started after the previous day's hemodialysis. The patient had voluntarily discontinued his antihypertensive medication 2 weeks before presentation and had high blood pressure with marked fluctuation during hemodialysis. Complete ptosis and ophthalmoplegia on the right side suggested 3rd, 4th, and 6th cranial nerve palsies. DIAGNOSES: Magnetic resonance imaging of the brain revealed a pituitary tumor, intratumoral hemorrhage within the sella, and symmetric vasogenic edema in the subcortical white matter in the parieto-occipital lobes. Based on these findings, the patient was diagnosed with PA and PRES. INTERVENTIONS: Intravenous administration of hydrocortisone (50âmg every 6âhours after a bolus administration of 100âmg) was initiated. Although surgical decompression was recommended based on the PA score (5/10), the patient declined surgery. OUTCOMES: Headache and ocular palsy gradually improved after supportive management. The patient was discharged on the 14th day of hospitalization with no recurrence 5 months post-presentation. Current therapy includes antihypertensive agents, oral prednisolone (7.5âmg/day), and maintenance hemodialysis. LESSONS: Neurologic abnormalities developed in a patient with ESRD on hemodialysis, suggesting the importance of prompt diagnosis and treatment in similar instances.
Assuntos
Falência Renal Crônica/terapia , Apoplexia Hipofisária/etiologia , Síndrome da Leucoencefalopatia Posterior/etiologia , Diálise Renal/efeitos adversos , Idoso , Anti-Inflamatórios/uso terapêutico , Humanos , Hidrocortisona/uso terapêutico , Imageamento por Ressonância Magnética , Masculino , Apoplexia Hipofisária/diagnóstico por imagem , Apoplexia Hipofisária/tratamento farmacológico , Síndrome da Leucoencefalopatia Posterior/diagnóstico por imagem , Síndrome da Leucoencefalopatia Posterior/tratamento farmacológicoAssuntos
Diabetes Insípido Neurogênico/induzido quimicamente , Glucocorticoides/efeitos adversos , Apoplexia Hipofisária/tratamento farmacológico , Adenoma/complicações , Adenoma/diagnóstico por imagem , Adenoma/cirurgia , Feminino , Glucocorticoides/uso terapêutico , Humanos , Pessoa de Meia-Idade , Apoplexia Hipofisária/complicações , Apoplexia Hipofisária/etiologia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/cirurgiaRESUMO
BACKGROUND: Whether conservative treatment or surgical management is the most appropriate treatment for pituitary apoplexy (PA) is controversial. In general, if severe symptoms of compression occur, such as oculomotor nerve palsy, neurosurgery is performed to relieve the compression of anatomical structures near the PA. CASE DESCRIPTION: We describe the case of a 79-year-old man who was found to have an intrasellar pituitary incidentaloma. The tumor was discovered accidentally, during an investigation into the cause of his dizziness. Two months later, he suddenly developed headaches, left ophthalmoplegia, decreased vision, severe blepharoptosis and diplopia. He was diagnosed with PA and hypocortisolemia based on magnetic resonance imaging (MRI) and blood tests, respectively. His symptoms of oculomotor palsy and optic nerve compression were serious, but his ophthalmological deficits were nonprogressive and his hormone levels improved through conservative treatment (hydrocortisone supplementation). Due to this older patient's poor physical condition and serious coronary heart disease, after multidisciplinary consultation and according to his family's wishes, we continued the conservative treatment and watched closely for any changes in the patient's condition. After 6 months of conservative treatment, the patient's symptoms of oculomotor nerve paralysis, pupil and vision defects completely disappeared, and no new complications occurred. Repeated MRI tests showed that the PA lesion gradually improved. The patient's hypocortisolemia was completely relieved through oral supplementation with low-dose hydrocortisone. CONCLUSION: In older PA patients who have surgical contraindications, even with symptoms of compression, such as oculomotor nerve palsy, according to the international guidelines, if conservative treatment is effective and the condition is not progressing, it is possible to monitor patients' condition closely and continue conservative treatment, which may yield good results.
Assuntos
Tratamento Conservador , Hidrocortisona/uso terapêutico , Apoplexia Hipofisária/tratamento farmacológico , Neoplasias Hipofisárias/complicações , Idoso , Humanos , Hidrocortisona/sangue , Achados Incidentais , Masculino , Síndromes de Compressão Nervosa/etiologia , Oftalmoplegia/etiologia , Nervo Óptico , Apoplexia Hipofisária/etiologia , Neoplasias Hipofisárias/diagnóstico por imagem , Transtornos da Visão/etiologiaRESUMO
A 56-year-old man noted sudden onset of headache, fever, right pupil-spared oculomotor nerve palsy and consciousness disturbance. Swelling of pituitary with T1 high intensity on brain MRI suggested the diagnosis of pituitary apoplexy. Considering significant decrease of pituitary anterior lobe hormone and central diabetes insipidus, high dose of hydrocortisone was administered. Eight days after onset, consciousness level and headache improved. On day 30, brain MRI revealed the reduction of mass size, and on day 46, photophobia and double vision disappeared. Following the rapid response to steroid and disappearance of pituitary lesion, pituitary apoplexy was probably caused by panhypophisitis. Thin-slice brain MRI confirmed the compression of oculomotor nerve at inlet zone of cavernous sinus, suggesting the mechanism of oculomotor palsy was perfusion impairment of feeding artery.
Assuntos
Hipofisite Autoimune/complicações , Imageamento por Ressonância Magnética , Síndromes de Compressão Nervosa/diagnóstico por imagem , Síndromes de Compressão Nervosa/etiologia , Nervo Oculomotor/diagnóstico por imagem , Apoplexia Hipofisária/diagnóstico por imagem , Apoplexia Hipofisária/etiologia , Hipofisite Autoimune/tratamento farmacológico , Diabetes Insípido/complicações , Diabetes Insípido/tratamento farmacológico , Humanos , Hidrocortisona/administração & dosagem , Masculino , Pessoa de Meia-Idade , Síndromes de Compressão Nervosa/tratamento farmacológico , Apoplexia Hipofisária/tratamento farmacológico , Hormônios Adeno-Hipofisários/deficiência , Resultado do TratamentoRESUMO
OBJECTIVES: To evaluate clinical presentations, diagnosis and management of paediatric patients presenting with pituitary apoplexy. METHODS: A retrospective case series describing a cohort of paediatric patients presenting with this condition from 2010-2016 to a tertiary referral children's hospital in the United Kingdom. RESULTS: Pituitary apoplexy is a rare condition that seems to have a higher relative incidence in children than adults. Our series suggests that pituitary apoplexy in paediatric patients with adenomas appears more common than previously described. All our patients required surgery, either as an acute or delayed procedure, for visual compromise. Two patients had commenced growth hormone (GH) for GH deficiency two weeks prior to the onset of pituitary apoplexy. CONCLUSIONS: With only a limited number of published case reports surrounding this topic our case series contributes to help further understand and manage this condition.
Assuntos
Apoplexia Hipofisária/diagnóstico por imagem , Apoplexia Hipofisária/diagnóstico , Neoplasias Hipofisárias/diagnóstico por imagem , Neoplasias Hipofisárias/diagnóstico , Prolactinoma/diagnóstico por imagem , Prolactinoma/diagnóstico , Adolescente , Feminino , Hormônio do Crescimento/uso terapêutico , Humanos , Imageamento por Ressonância Magnética , Masculino , Apoplexia Hipofisária/tratamento farmacológico , Neoplasias Hipofisárias/tratamento farmacológico , Prolactinoma/tratamento farmacológico , Estudos RetrospectivosAssuntos
Inibidores de Ciclo-Oxigenase/uso terapêutico , Indometacina/uso terapêutico , Hemicrania Paroxística/tratamento farmacológico , Hemicrania Paroxística/etiologia , Apoplexia Hipofisária/complicações , Adenoma/complicações , Adenoma/tratamento farmacológico , Idoso , Humanos , Masculino , Apoplexia Hipofisária/tratamento farmacológico , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/tratamento farmacológicoRESUMO
Pituitary apoplexy (PA), defined by the occurrence of a massive hemorrhagic necrotic rearrangement within a pituitary adenoma, is rare. Its occurrence can be associated with certain risk factors, including anticoagulation. We report the first case of PA with rivaroxaban which is one of the new oral anticoagulants: a 73 year-old patient presenting with severe headache and visual field deterioration. Surgery was performed. Radiotherapy treatment was decided three months after surgery because of tumor residue.
Assuntos
Apoplexia Hipofisária/diagnóstico , Apoplexia Hipofisária/tratamento farmacológico , Neoplasias Hipofisárias/complicações , Rivaroxabana/uso terapêutico , Idoso , Humanos , Masculino , Apoplexia Hipofisária/etiologiaRESUMO
BACKGROUND: Pituitary tumor apoplexy is a rare clinical syndrome caused by acute hemorrhage or infarction in a preexisting pituitary adenoma. It typically manifests as an acute episode of headache, visual disturbance, mental status changes, cranial nerve palsy, and endocrine pituitary dysfunction. However, not all patients present with classical symptoms, so it is pertinent to appreciate the clinical spectrum of pituitary tumor apoplexy presentation. We report an unusual case of a patient with pituitary tumor apoplexy who presented with periorbital edema associated with hypopituitarism. CASE PRESENTATION: An 83-year-old Japanese man developed acute anterior hypopituitarism; he showed anorexia, fatigue, lethargy, severe bilateral periorbital edema, and mild cardiac dysfunction in the absence of headache, visual disturbance, altered mental status, and cranial nerve palsy. Magnetic resonance imaging showed a 2.5-cm pituitary tumor containing a mixed pattern of solid and liquid components indicating pituitary tumor apoplexy due to hemorrhage in a preexisting pituitary adenoma. Replacement therapy with oral hydrocortisone and levothyroxine relieved his symptoms of central adrenal insufficiency, central hypothyroidism, periorbital edema, and cardiac dysfunction. CONCLUSIONS: Common causes of periorbital edema include infections, inflammation, trauma, allergy, kidney or cardiac dysfunction, and endocrine disorders such as primary hypothyroidism. In the present case, the patient's acute central hypothyroidism was probably involved in the development of both periorbital edema and cardiac dysfunction. The present case highlights the need for physicians to consider periorbital edema as an unusual predominant manifestation of pituitary tumor apoplexy.
Assuntos
Adenoma/diagnóstico por imagem , Hipopituitarismo/diagnóstico , Hemorragias Intracranianas/diagnóstico por imagem , Apoplexia Hipofisária/diagnóstico , Neoplasias Hipofisárias/diagnóstico por imagem , Disfunção Ventricular Esquerda/diagnóstico por imagem , Doença Aguda , Adenoma/complicações , Idoso de 80 Anos ou mais , Edema/etiologia , Humanos , Hidrocortisona/uso terapêutico , Hipopituitarismo/tratamento farmacológico , Hipopituitarismo/etiologia , Hemorragias Intracranianas/complicações , Imageamento por Ressonância Magnética , Masculino , Órbita , Apoplexia Hipofisária/complicações , Apoplexia Hipofisária/tratamento farmacológico , Neoplasias Hipofisárias/complicações , Tiroxina/uso terapêutico , Disfunção Ventricular Esquerda/etiologia , Complexos Ventriculares Prematuros/diagnóstico , Complexos Ventriculares Prematuros/etiologiaAssuntos
Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/etiologia , Apoplexia Hipofisária/complicações , Apoplexia Hipofisária/diagnóstico , Adenoma/complicações , Adenoma/diagnóstico , Adenoma/tratamento farmacológico , Adulto , Hemorragia Cerebral/complicações , Hemorragia Cerebral/diagnóstico , Hemorragia Cerebral/tratamento farmacológico , Diagnóstico Diferencial , Feminino , Humanos , Transtornos de Enxaqueca/tratamento farmacológico , Apoplexia Hipofisária/tratamento farmacológico , Hipófise/diagnóstico por imagem , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/tratamento farmacológicoRESUMO
We report the case of an older lady who was admitted to a tertiary teaching hospital with sub-acute functional decline of two months' duration, which was initially attributed to a concomitant urinary tract infection. Further investigations, however, revealed the diagnosis of pituitary apoplexy with central hypocortisolism. Subsequent treatment with physiological doses of steroids improved patient's function and overall well-being. This report adds to the sparse literature on pituitary apoplexy in the older adults and emphasizes the non-specific presentation of this clinical syndrome.
Assuntos
Transtornos Cognitivos/etiologia , Cognição , Apoplexia Hipofisária/complicações , Idoso de 80 Anos ou mais , Cognição/efeitos dos fármacos , Transtornos Cognitivos/diagnóstico por imagem , Transtornos Cognitivos/psicologia , Diagnóstico Diferencial , Feminino , Humanos , Hidrocortisona/uso terapêutico , Imageamento por Ressonância Magnética , Apoplexia Hipofisária/diagnóstico por imagem , Apoplexia Hipofisária/tratamento farmacológico , Apoplexia Hipofisária/fisiopatologia , Valor Preditivo dos Testes , Recuperação de Função Fisiológica , Fatores de Risco , Resultado do TratamentoAssuntos
Anti-Inflamatórios/administração & dosagem , Hidrocortisona/administração & dosagem , Imageamento por Ressonância Magnética , Apoplexia Hipofisária/diagnóstico , Neoplasias Hipofisárias/diagnóstico , Transtornos da Visão/tratamento farmacológico , Idoso de 80 Anos ou mais , Cefaleia/etiologia , Humanos , Injeções Intravenosas , Masculino , Apoplexia Hipofisária/complicações , Apoplexia Hipofisária/tratamento farmacológico , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/tratamento farmacológico , Resultado do Tratamento , Transtornos da Visão/etiologiaAssuntos
Anticoagulantes/administração & dosagem , Apoplexia Hipofisária/tratamento farmacológico , Adenoma/complicações , Adenoma/tratamento farmacológico , Adenoma/cirurgia , Administração Oral , Idoso , Feminino , Humanos , Hemorragias Intracranianas/tratamento farmacológico , Hemorragias Intracranianas/cirurgia , Apoplexia Hipofisária/etiologia , Apoplexia Hipofisária/cirurgia , Neoplasias Hipofisárias/complicações , Neoplasias Hipofisárias/tratamento farmacológico , Neoplasias Hipofisárias/cirurgiaRESUMO
Pituitary apoplexy is a rare event in which the pituitary gland undergoes infarction or haemorrhage, most commonly in the setting of an underlying tumour. We report on apoplexy of an undiagnosed pituitary adenoma precipitated both by physiological enlargement of the pituitary in pregnancy and prophylactic anticoagulation from a history of deep vein thrombosis. The haemorrhage was managed conservatively without significant complications.