Case ReportRemission of Acromegaly After Pituitary Apoplexy: Case Report and Review of Literature
Section snippets
INTRODUCTION
Pituitary apoplexy is a rare complication of pituitary adenomas. It has been reported in 0.6% to 10% of surgically resected adenomas (1). Apoplexy is caused by hemorrhage or infarction of the pituitary gland (usually in a preexisting pituitary adenoma) and can vary from an asymptomatic event found on magnetic resonance imaging (MRI) or computed tomography (CT) to a life-threatening endocrine emergency (1). Acute swelling of the tumor can cause compression of nearby structures, resulting in the
CASE PRESENTATION
A 34-year-old man was referred to our clinic in August 2007, after his family physician noticed the large size of his hands. The patient reported classic signs and symptoms of acromegaly, including enlarged jaw and nose, widely spaced teeth, worsening sleep apnea, tightening of his gloves, an increase in shoe size from 11 (in 2000) to 14, sweaty oily skin, and skin tags. During the preceding 6 months, he had been diagnosed with new diabetes and hypertension.
Results of laboratory tests were as
REVIEW OF LITERATURE
We performed a review of the literature, searching for other case reports of remission of acromegaly after pituitary apoplexy. We searched PubMed using the keywords “acromegaly,” “apoplexy,” and “remission.” This search yielded 17 articles, 14 of which were relevant. The search was repeated on Ovid MEDLINE, and the same 17 articles were again retrieved. In addition, we found 4 other case reports that were referenced in these 17 articles, resulting in a total of 21 reported cases.
All the
DISCUSSION
Our case demonstrates that acromegaly can go into remission after pituitary apoplexy, an effect that has been documented in 21 other case reports. Apoplexy may also result in insufficient secretion of other pituitary hormones. In a 2008 review of pituitary apoplexy, Nawar et al (1) found a wide variation in the reported rates of hormonal dysfunction at the time of presentation, with adrenal insufficiency reported in 50% to 100% of cases, thyroid dysfunction in 25% to 75%, and gonadal
CONCLUSION
Pituitary apoplexy can occur in patients with GH- producing adenomas and should be considered in any patient with a known pituitary adenoma who presents with a new severe headache. In patients with acromegaly, pituitary apoplexy may result not only in normal or deficient GH production but also in pituitary insufficiency necessitating immediate treatment. After apoplexy, reevaluation of pituitary hormone secretion is necessary and may prompt changes in GH suppressive therapy and initiation of
DISCLOSURE
The authors have no multiplicity of interest to disclose.
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Cited by (37)
Pituitary Apoplexy: Results of Surgical and Conservative Management Clinical Series and Review of the Literature
2019, World NeurosurgeryCitation Excerpt :Eight patients with nonsecreting adenomas (57.1%) achieved complete regression after apoplexy. Although tumor regression after apoplexy is a described event, specific data about complete tumor regression are scarce and most are case reports.26,35-38 Our study adds data that support this association.
Pituitary apoplexy presenting as an intraventricular hemorrhage: An infrequent neurovascular emergency
2017, Interdisciplinary Neurosurgery: Advanced Techniques and Case ManagementCitation Excerpt :Most of pituitary adenomas presenting with a PA are defined as non-functioning; however, the syndrome can also be originated from secreting tumors. Accordingly, this syndrome has been shown also in patients with clinical manifestations of Cushing disease, acromegaly and prolactinomas [6,7,8]. Hemorrhage within the pituitary tumor as well as hemorrhagic extension to the ventricles, may be the result of three main mechanisms: disproportionate growth in relation to blood flow, concomitant use of anticoagulation therapy or pharmacological inhibition of the adenoma [8].
Preoperative Evaluation of Sellar and Parasellar Macrolesions by [<sup>18</sup>F]Fluorodeoxyglucose Positron Emission Tomography
2017, World NeurosurgeryCitation Excerpt :Spontaneous remission of GH-secreting adenoma is a well-known phenomenon. Subclinical pituitary apoplexy may be one of the causative factors.20-22 GH-secreting adenoma may easily undergo minor diffuse vascular change and degeneration during long periods.23
Pituitary tumor apoplexy
2015, Journal of Clinical NeuroscienceCitation Excerpt :An outline of the biochemical evaluation of patients who present with suspected or confirmed PTA is presented in Table 4. It is not uncommon to have clinical and biochemical resolution of hormonally hyper-functioning pituitary adenomas (including Cushing’s disease and acromegaly) as a result of infarction after the apoplectic event has been reported [34,83–85]. Compared to CT scans, MRI of the sella is superior in detecting tumor and hemorrhage/infarct (as well as MRI utility in estimating the time of onset of hemorrhage) and detecting superior and lateral tumor extension.
A case of acromegaly complicated with diabetic ketoacidosis, pituitary apoplexy, and lymphoma
2013, Kaohsiung Journal of Medical SciencesCitation Excerpt :Hypopituitarism is supported by fluid resuscitation and hormone replacement [5]. Some cases have experienced spontaneous remission of acromegaly after pituitary apoplexy [11]. Our patient had no visual defect and hypopituitarism because of the limited hemorrhage in the adenoma, so elevated GH persisted.
Published as a Rapid Electronic Article in Press at http://www.endocrinepractice.org on June 22, 2009. DOI: 10.4158/EP09126.CRR