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Cerebral ischaemia in pituitary apoplexy

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Abstract

Pituitary apoplexy is a potentially fatal condition that can have serious consequences even after successful treatment. One of the potential complications of this syndrome is occlusion of the internal carotid arteries, which causes cerebral ischaemia. This can occur through one of two mechanisms—direct compression of the artery or vasospasm caused by factors released from haemorrhagic or necrotic material. We illustrate two examples of cerebral ischaemia with pituitary apoplexy, one with compression and one with vasospasm, both ending in a successful resolution. In both, magnetic resonance imaging, angiography, and hormonal studies allow diagnosis, and urgent surgical decompression should be the treatment of choice. We review the literature and discuss the mechanisms.

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Authors and Affiliations

  1. Groote Schuur Hospital, Cape Town, South Africa

    Shahzada K. Ahmed & Patrick L. Semple

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  1. Shahzada K. Ahmed
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  2. Patrick L. Semple
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Correspondence to Shahzada K. Ahmed.

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Comment

In this paper, the authors have highlighted the importance of conducting early MRI/angiogram and hormonal measurements in patients suspected of presenting with pituitary apoplexy (PA). In fact, the symptoms of PA can easily be confused with those of sudden carotid vessel obstruction due to thrombosis and associated ischaemic stroke. CT/MRI scans should be conducted on any patient admitted to A and E and presenting with these symptoms. In this paper, the authors used these conventional technologies to identify haemorrhagic regions within the adenoma and associated infarction of the cerebral arteries.

Bearing in mind that many of the elder patients will have significant degrees of carotid artery stenosis and some with unstable atherosclerotic plaques, the effects of vasospasm caused by release of vasoactive substances or direct arterial compression due to rapid tumour expansion must be considered to be potentially life threatening. For this reason, trans-sphenoidal decompression should be carried out immediately to limit the risk of permanent neurological damage caused by cerebral artery occlusion. Further studies are warranted to define the prevalence of vasospasm-induced ischaemia and identify the secreted substances responsible in order to develop efficient counteractive clinical therapeutics.

Mark Slevin

Hospital de la Santa Creu i Sant Pau, Barcelona

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Ahmed, S.K., Semple, P.L. Cerebral ischaemia in pituitary apoplexy. Acta Neurochir (Wien) 150, 1193–1196 (2008). https://doi.org/10.1007/s00701-008-0130-3

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  • DOI: https://doi.org/10.1007/s00701-008-0130-3

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