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1.
Arq. bras. neurocir ; 40(4): 364-367, 26/11/2021.
Article in English | LILACS | ID: biblio-1362102

ABSTRACT

Pituitary apoplexy (PA) is a clinical diagnosis comprising a sudden onset of headache, neurological deficits, endocrine disturbances, altered consciousness, visual loss, or ophthalmoplegia. However, clinically, the presentation of PA is extremely variable and occasionally fatal. While meningitis and cerebral infarcts are themselves serious diseases, they are rarely seen as manifestations of PA and are exceedingly rare when present together. We present the case of a 20-year-old male with a rapid progression of symptoms of meningitis, PA and stroke. The present article seeks to emphasize a rare manifestation of PA with an attempt to understand the intricacies of its evaluation and management.


Subject(s)
Humans , Male , Adult , Pituitary Apoplexy/surgery , Pituitary Apoplexy/etiology , Meningitis, Bacterial/complications , Stroke/complications , Spinal Puncture/methods , Pituitary Apoplexy/diagnostic imaging , Cerebral Infarction/complications , Endoscopy/methods
2.
Rev. cuba. endocrinol ; 28(3): 1-13, set.-dic. 2017. ilus
Article in Spanish | LILACS | ID: biblio-901028

ABSTRACT

Antecedentes: la apoplejía hipofisaria es un síndrome clínico agudo, potencialmente fatal, que acontece como complicación de un adenoma hipofisario; presenta una complejidad diagnóstica, y puede imitar numerosos procesos intracraneales. Objetivo: realizar la revisión bibliográfica del tema, y describir dos casos clínicos, dada la poca frecuencia de presentación de la enfermedad y su complejidad diagnóstica. Desarrollo: caso 1, paciente masculino, de 52 años con antecedentes patológicos de hipertensión arterial y macroadenoma hipofisario no funcionante. Durante su seguimiento por Neurocirugía se detectó hiperprolactinemia, por lo que se inició tratamiento con bromocriptina a dosis progresiva, lo cual desencadenó cuadro agudo no definido. Tres meses después presentó nuevo cuadro agudo, que se diagnosticó como apoplejía hipofisaria; caso 2, paciente masculino, de 49 años, con antecedente de hipertensión arterial con tratamiento irregular. Fue ingresado en servicio de terapia intermedia con diagnóstico presuntivo de meningoencefalitis, y por estudios complementarios se llega al diagnóstico de apoplejía hipofisaria. Ambos casos llevaron tratamiento quirúrgico, con evolución favorable. Conclusiones: la apoplejía hipofisaria es una enfermedad que se presenta con poca frecuencia, por lo tanto, es importante la sospecha diagnóstica para una temprana identificación y tratamiento de la enfermedad(AU)


Background: pituitary apoplexy is an acute clinical syndrome, potentially fatal, that occurs as a complication of a pituitary adenoma. It presents a diagnostic complexity, and it can mimic numerous intracranial processes. Objective: to carry out the bibliographic review of the subject, and to describe two clinical cases given the infrequency of presentation of the disease and its diagnostic complexity. Development: case 1, male patient, 52 years old with pathological history of arterial hypertension and non-functioning pituitary macroadenoma. During follow-up by Neurosurgery, hyperprolactinemia was detected, so treatment with bromocriptine was started with a progressive dose, which triggered undefined acute symptoms. Three months later he presented new acute symptoms, which was diagnosed as pituitary apoplexy. Case 2, male patient, 49 years old, with a history of arterial hypertension under irregular treatment. He was admitted in the intermediate therapy service with a presumptive diagnosis of meningoencephalitis, and by complementary studies the diagnosis of pituitary apoplexy was reached. Both cases led to surgical treatment, with favorable evolution. Conclusions: pituitary apoplexy is a disease that occurs infrequently, therefore, diagnostic suspicion is important for early identification and treatment of the disease(AU)


Subject(s)
Humans , Male , Middle Aged , Bibliographies as Topic , Pituitary Apoplexy/surgery , Pituitary Apoplexy/diagnosis , Hyperprolactinemia/drug therapy , Review Literature as Topic
3.
Arq. neuropsiquiatr ; 67(2a): 328-333, June 2009. ilus
Article in English | LILACS | ID: lil-517055

ABSTRACT

Pituitary tumor apoplexy is a medical emergency due to acute infarction or hemorrhage in the pituitary gland. In this review, the authors discuss the sellar anatomy, the pituitary gland and adenomas' vascularization and the general aspects of the syndrome such as its ethiopatogenesis, predisposing factors, clinical features, treatment and prognosis.


A apoplexia em tumor hipofisário é uma emergência médica decorrente do infarto agudo ou hemorrágico na glândula hipófise. Nesta revisão os autores discutem a anatomia da região selar, a vascularização da hipófise e adenomas hipofisários, e demais aspectos da síndrome como etiopatogenia, fatores predisponentes, quadro clínico, tratamento e prognóstico.


Subject(s)
Humans , Pituitary Apoplexy/etiology , Pituitary Neoplasms/complications , Prognosis , Pituitary Apoplexy/pathology , Pituitary Apoplexy/surgery , Pituitary Neoplasms/pathology , Pituitary Neoplasms/surgery , Risk Factors
4.
Rev. méd. Chile ; 128(9): 1015-8, sept. 2000. ilus, tab
Article in Spanish | LILACS | ID: lil-274635

ABSTRACT

We report a man in whom a 15 cm. renal tumor was excised at the age of 49. The pathological examination showed a clear cell carcinoma. Five years later, he presented with headache, vomiting and unilateral palpebral ptosis. Imaging studies showed a sellar tumor with pituitary apoplexy. The tumor was excised and the pathological study disclosed a clear cell tumor, positive for vimentin, cytokeratins AE1 and AE3 and immunohistochemically negative for LH, TSH, ACTH and GH. Considering the similar histopathological features, it was considered as a metastasis of the renal tumor. The patient was supplemented with thyroid, adrenal and gonadal hormones. Seven years later, he presented a new tumor in the remaining kidney, that corresponded to a cystic papillary renal cell carcinoma. Afterwards, he presented a transitional urinary bladder tumor. Mortality associated to renal cell tumors is 90 percent at 5 years, and pituitary metastases are extraordinarily uncommon


Subject(s)
Humans , Male , Middle Aged , Pituitary Neoplasms/secondary , Pituitary Apoplexy/etiology , Carcinoma, Renal Cell/complications , Pituitary Neoplasms/complications , Pituitary Apoplexy/surgery , Pituitary Apoplexy/diagnosis , Follow-Up Studies , Neoplasm Metastasis , Nephrectomy , Carcinoma, Renal Cell/surgery , Diagnosis, Differential
5.
Arq. neuropsiquiatr ; 57(1): 74-7, mar. 1999. ilus
Article in Portuguese | LILACS | ID: lil-231881

ABSTRACT

Apoplexia pituitária aguda é fenômeno relativamente raro, mesmo em macroadenomas. No entanto, a presença de áreas necro-hemorrágicas intratumorais nestes tumores que nao se relacionam a qualquer sintomatologia aguda parece ser bem mais frequente do que se imaginava na era da tomografia. Com o advento da ressonância magnética estas áreas podem ser facilmente diagnosticadas pré-operatoriamente. Dentre os 40 últimos macroadenomas operados e examinados com RMN, 10 possuíam áreas apopléticas subclínicas em seu interior. Sete destes tumores eram nao secretores, 2 secretores de Gh e um de prolactina. O quadro clínico incluiu, além daqueles correspondentes à aventual secreçao endócrina, perda visual progressiva (sem história de piora abrupta ou rápida) (n=8) e cefaléia (n=3). Após a remoçao cirúrgica destes tumores e descompressao do aparato óptico, obtivemos melhora visual em 6 pacientes e em 2 a visao permaneceu inalterada. A cefaléia desapareceu em 2 casos. A presença de áreas apopléticas nestes macrotumores bem como sua ausência em séries de microtumores relatadas na literatura sugere que se relacionam mais ao tamanho do tumor do que ao seu caráter secretor ou nao, o que é compatível com a provável natureza (insuficiência vascular) da apoplexia subclínica nesses casos.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Adenoma/diagnosis , Pituitary Apoplexy/diagnosis , Pituitary Neoplasms/diagnosis , Adenoma/surgery , Magnetic Resonance Imaging , Pituitary Apoplexy/surgery , Pituitary Neoplasms/surgery
6.
Arq. neuropsiquiatr ; 55(4): 818-25, dez. 1997. ilus, tab
Article in Portuguese | LILACS | ID: lil-209382

ABSTRACT

Os autores analisam a literatura sobre apoplexia hipofisária intradenomatosa, enfocando a fisiopatologia, o diagnóstico e a conduta terapêutica. Estudam 5 casos, de uma série de 86 pacientes com tumores hipofisários que desenvolveram esta síndrome e que foram diagnosticados e acompanhados pelos serviços de Neurocirurgia e Endocrinologia do Hospital Universitário Clementino Fraga Filho da Universidade Federal do Rio de Janeiro. Todos os casos, a partir da suspeita clínica, tiveram o diagnóstico confirmado por estudo de tomografia computadorizada de crânio e/ou ressonância magnética de crânio. O tratamento de escolha foi cirúrgico. As conclusöes apontam para as dificuldades diagnósticas desta situaçao clínica e da urgência na instituiçäo da terapia.


Subject(s)
Male , Humans , Female , Middle Aged , Adult , Adenoma/diagnosis , Pituitary Apoplexy/diagnosis , Pituitary Neoplasms/diagnosis , Adenoma/physiopathology , Magnetic Resonance Imaging , Pituitary Apoplexy/surgery , Pituitary Gland/pathology , Pituitary Neoplasms/physiopathology
7.
Arq. bras. neurocir ; 14(4): 176-82, dez. 1995. ilus, tab
Article in Portuguese | LILACS | ID: lil-186618

ABSTRACT

Nove pacientes operados portadores de macroadenomas hipofisários que apresentaram hemorragia intratumoral foram revisados. O diagnóstico baseou-se nos sinais e sintomas clínicos, tomografia computadorizada (TC), ressonância nuclear magnética (RNM) e estudo histológico. Todos os tumores apresentavam expansäo supra-selar. Cinco pacientes tiveram sintomas agudos como cefaléia, vômitos, meningismo, diplopia e déficit da acuidade e do campo visual, enquanto 4 tiveram hemorragia "assintomática". Os pacientes foram operados pela via transesfenoidal e, à cirurgia, 6 apresentavam coleçäo sangüínea e 3, enfarte hemorrágico. O tempo médio entre a admissäo e a cirurgia foi de 18 días. Näo houve mortalidade operatória. A cirurgia proporcionou a melhora dos sintomas visuais e oculomotores na grande maioria dos pacientes, porém näo trouxe melhora da funçäo endócrina.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Adenoma/complications , Pituitary Apoplexy/complications , Brain Neoplasms/complications , Cerebral Hemorrhage/complications , Pituitary Gland , Pituitary Neoplasms/complications , Adenoma/diagnosis , Adenoma/surgery , Pituitary Apoplexy/surgery , Brain Neoplasms/diagnosis , Brain Neoplasms/surgery , Cerebral Hemorrhage/surgery , Pituitary Neoplasms/diagnosis , Pituitary Neoplasms/surgery , Magnetic Resonance Spectroscopy , Tomography, X-Ray Computed , Treatment Outcome
8.
Neuroeje ; 6(3): 81-85, 1988. ilus
Article in Spanish | LILACS | ID: lil-581817

ABSTRACT

Se hace la presentación de un caso clínico portador de apoplejía hipofisiaria con cuadro agregado de hidrocefalia aguda, manejada en una forma inmediata tanto médica como quirúrgica, utilizando todo el arsenal con que se contaba en ese momento y observando los frutos, en una recuperación y pronóstico excelente a través de un seguimiento de más de 36 meses. Hemos realizado una revisión de la literatura al respecto y creemos que estamos en condiciones adecuadas para el diagnóstico, manejo y tratamiento de futuros casos, gracias a la ayuda de un equipo interdisciplinario.


Subject(s)
Humans , Male , Adult , Pituitary Apoplexy/surgery , Pituitary Apoplexy/diagnosis , Pituitary Apoplexy/physiopathology , Pituitary Apoplexy/therapy , Pituitary Gland/abnormalities , Pituitary Gland/physiopathology , Costa Rica
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