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Pituitary tumor apoplexy in patients with Cushing’s disease: endocrinologic and visual outcomes after transsphenoidal surgery

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Abstract

Pituitary apoplexy in patients with adrenocorticotropic hormone (ACTH) producing tumors is a rare occurrence. We report four patients with Cushing’s disease harboring ACTH-secreting macroadenomas who presented with pituitary apoplexy. We report the endocrinologic and visual outcomes of these patients after emergent transsphenoidal surgery. A retrospective chart review was performed in 4 patients who presented with pituitary apoplexy from hemorrhage into an ACTH-secreting pituitary adenoma. The patient charts were reviewed for clinical presentation, neuroimaging findings, intraoperative surgical findings, pathologic findings, and postoperative endocrinologic and visual outcomes. All patients presented with acute headaches, nausea, vomiting, and visual loss from optic compression. MR imaging demonstrated a hemorrhagic macroadenoma that was confirmed at surgery. All patients underwent emergent transsphenoidal decompression (within 24 h of presentation). One of these underwent an additional craniotomy to resect residual tumor. Postoperatively, all patients showed significant improvement in visual acuity and visual fields with biochemical remission confirmed on laboratory testing. Significant weight loss as well as resolution of diabetes and hypertension was noted in all cases. All four patients remained in biochemical remission at their most recent follow-up visit (mean 40 months, range: 24–72 months). Excellent endocrine and visual outcomes can be achieved after emergent transsphenoidal surgery in patients with Cushing’s disease presenting with pituitary apoplexy. Although the cure rates of non-apoplectic ACTH macroadenomas are generally poor, higher rates of remission can be achieved in cases of pituitary apoplexy. This may be partly due to the effects of tumor infarction.

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Authors and Affiliations

  1. Department of Neurological Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, 90 Bergen St, Suite 8100, Newark, NJ, 07101, USA

    Osamah J. Choudhry, Asad J. Choudhry & James K. Liu

  2. Division of Endocrinology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA

    Elkin A. Nunez

  3. Department of Otolaryngology—Head and Neck Surgery, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA

    Jean Anderson Eloy

  4. Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, New Jersey Medical School, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA

    Jean Anderson Eloy & James K. Liu

  5. Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, UT, USA

    William T. Couldwell

  6. Division of Neurosurgery, NorthShore University Health System, Evanston, IL, USA

    Ivan S. Ciric

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  1. Osamah J. Choudhry
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  2. Asad J. Choudhry
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Correspondence to James K. Liu.

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Choudhry, O.J., Choudhry, A.J., Nunez, E.A. et al. Pituitary tumor apoplexy in patients with Cushing’s disease: endocrinologic and visual outcomes after transsphenoidal surgery. Pituitary 15, 428–435 (2012). https://doi.org/10.1007/s11102-011-0342-z

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