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Pituitary apoplexy in an adrenocorticotropin-producing pituitary macroadenoma

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Abstract

Adrenocorticotropin (ACTH) producing macroadenomas and pituitary apoplexy are unusual in Cushing’ s disease. A 20-year-old man who had been diagnosed Cushing’ s disease 2 months ago, presented with sudden headache, nausea, and vomiting. His serum cortisol level was 0.4 μg/dl and ACTH level was 23.9 pg/ml. Magnetic resonance imaging of the pituitary gland disclosed a hemorrhage in the pituitary macroadenoma (22 × 19 mm). He was treated with IV methylprednisolone immediately and then the symptoms were relieved within the first day of the treatment. The hemorrhagic lesion was resected by transsphenoidal surgery successfully. Impaired secretion of pituitary hormones may be seen after the pituitary apoplexy. We communicate a case with pituitary apoplexy of an ACTH secreting pituitary macroadenoma, causing acute glucocorticoid insufficiency.

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References

  1. D.C. Bills, F.B. Meyer, E.R. Laws, Jr., D.H. Davis, M.J. Ebersold, B.W. Scheithauer, D.M. Ilstrup, C.F. Abboud, A retrospective analysis of pituitary apoplexy. Neurosurgery 33(4), 602–608 (1993)

    Article  CAS  PubMed  Google Scholar 

  2. W. Bonicki, A. Kasperlik-Załuska, W. Koszewski, W. Zgliczyński, J. Wisławski, Pituitary apoplexy: endocrine, surgical and oncological emergency Incidence, clinical course and treatment with reference to 799 cases of pituitary adenomas. Acta Neurochir. (Wien.) 120(3–4), 118–122 (1993)

    Article  CAS  Google Scholar 

  3. H.S. Randeva, J. Schoebel, J. Byrne, M. Esiri, C.B. Adams, J.A. Wass, Classical pituitary apoplexy: clinical features, management and outcome. Clin. Endocrinol. (Oxf.) 51(2), 181–188 (1999)

    Article  CAS  Google Scholar 

  4. L. Sibal, S.G. Ball, V. Connolly, R.A. James, P. Kane, W.F. Kelly, P. Kendall-Taylor, D. Mathias, P. Perros, R. Quinton, B. Vaidya, Pituitary apoplexy: a review of clinical presentation, management and outcome in 45 cases. Pituitary 7(3), 157–163 (2004)

    Article  PubMed  Google Scholar 

  5. A.S. Dubuisson, A. Beckers, A. Stevenaert, Classical pituitary tumour apoplexy: clinical features, management and outcomes in a series of 24 patients. Clin. Neurol. Neurosurg. 109(1), 63–70 (2007). Epub 2006 Feb 20

    Article  PubMed  Google Scholar 

  6. Verrees M, Arafah BM, Selman WR. Pituitary tumor apoplexy: characteristics, treatment, and outcomes. Neurosurg. Focus. 16(4), E6 (2004) (review)

  7. P.L. Semple, M.K. Webb, J.C. de Villiers, E.R. Laws, Jr., Pituitary apoplexy. Neurosurgery 56(1), 65–72 (2005). (discussion 72–73)

    PubMed  Google Scholar 

  8. E.H. Nielsen, J. Lindholm, P. Bjerre, J.S. Christiansen, C. Hagen, S. Juul, J. Jørgensen, A. Kruse, P. Laurberg, Frequent occurrence of pituitary apoplexy in patients with non-functioning pituitary adenoma. Clin. Endocrinol. (Oxf.) 64(3), 319–322 (2006)

    Article  Google Scholar 

  9. C.A. Rolih, K.P. Ober, Pituitary apoplexy. Endocrinol. Metab. Clin. North Am. 22(2), 291–302 (1993)

    CAS  PubMed  Google Scholar 

  10. V. Araya, I. Solís, M. Lemp, S. Oviedo, Partial remission of hypercortisolism in Cushing disease after pituitary apoplexy. A case report. Rev. Med. Chil. 126(12), 1497–1501 (1998)

    CAS  PubMed  Google Scholar 

  11. W.J. Inder, P.J. Hunt, Glucocorticoid replacement in pituitary surgery: guidelines for perioperative assessment and management. J. Clin. Endocrinol. Metab. 87(6), 2745–2750 (2002)

    Article  CAS  PubMed  Google Scholar 

  12. A. Krikorian, D. Abdelmannan, W.R. Selman, B.M. Arafah, Cushing disease: use of perioperative serum cortisol measurements in early determination of success following pituitary surgery. Neurosurg. Focus 23(3), E6 (2007)

    Article  PubMed  Google Scholar 

  13. J.C. Ausiello, J.N. Bruce, P.U. Freda, Postoperative assessment of the patient after transsphenoidal pituitary surgery. Pituitary 11(4), 391–401 (2008)

    Article  PubMed  Google Scholar 

  14. Y.S. Woo, A.M. Isidori, W.Z. Wat, G.A. Kaltsas, F. Afshar, I. Sabin, P.J. Jenkins, J.P. Monson, G.M. Besser, A.B. Grossman, Clinical and biochemical characteristics of adrenocorticotropin- secreting macroadenomas. J. Clin. Endocrinol. Metab. 90, 4963–4969 (2005)

    Article  CAS  PubMed  Google Scholar 

  15. S. Cannavò, B. Almoto, C. Dall’Asta, S. Corsello, R.M. Lovicu, E. De Menis, F. Trimarchi, B. Ambrosi, Long-term results of treatment in patients with ACTH-secreting pituitary macroadenomas. Eur. J. Endocrinol. 149(3), 195–200 (2003)

    Article  PubMed  Google Scholar 

  16. P. Rotman-Pikielny, N. Patronas, D.A. Papanicolaou, Pituitary apoplexy induced by corticotrophin-releasing hormone in a patient with Cushing’s disease. Clin. Endocrinol. (Oxf.) 58(5), 545–549 (2003)

    Article  Google Scholar 

  17. B.W. Scheithauer, A.J. Jaap, E. Horvath, K. Kovacs, R.V. Lloyd, F.B. Meyer, E.R. Laws, Jr., W.F. Young, Jr., Clinically silent corticotroph tumors of the pituitary gland. Neurosurgery 47(3), 723–729 (2000)

    Article  CAS  PubMed  Google Scholar 

  18. R.N. Nawar, D. AbdelMannan, W.R. Selman, B.M. Arafah, Pituitary tumor apoplexy: a review. J. Intensive Care Med. 23(2), 75–90 (2008). Review

    Article  PubMed  Google Scholar 

  19. D.H. Zayour, W.R. Selman, B.M. Arafah, Extreme elevation of intrasellar pressure in patients with pituitary tumor apoplexy: relation to pituitary function. J. Clin. Endocrinol. Metab. 89(11), 5649–5654 (2004)

    Article  CAS  PubMed  Google Scholar 

  20. J.D. Veldhuis, J.M. Hammond, Endocrine function after spontaneous infarction of the human pituitary: report, review, and reappraisal. Endocr. Rev. 1(1), 100–107 (1980)

    Article  CAS  PubMed  Google Scholar 

  21. B.M. Arafah, J.F. Harrington, Z.T. Madhoun, W.R. Selman, Improvement of pituitary function after surgical decompression for pituitary tumor apoplexy. J. Clin. Endocrinol. Metab. 71(2), 323–328 (1990)

    Article  CAS  PubMed  Google Scholar 

  22. B.M. Arafah, Reversible hypopituitarism in patients with large nonfunctioning pituitary adenomas. J. Clin. Endocrinol. Metab. 62(6), 1173–1179 (1986)

    Article  CAS  PubMed  Google Scholar 

  23. B.M. Arafah, S.H. Kailani, K.E. Nekl, R.S. Gold, W.R. Selman, Immediate recovery of pituitary function after transsphenoidal resection of pituitary macroadenomas. J. Clin. Endocrinol. Metab. 79(2), 348–354 (1994)

    Article  CAS  PubMed  Google Scholar 

  24. B.M. Arafah, D. Prunty, J. Ybarra, M.L. Hlavin, W.R. Selman, The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas. J. Clin. Endocrinol. Metab. 85(5), 1789–1793 (2000)

    Article  CAS  PubMed  Google Scholar 

  25. E. Vidal, R. Cevallos, J. Vidal, R. Ravon, J.J. Moreau, A.M. Rogues, V. Loustaud, F. Liozon, Twelve cases of pituitary apoplexy. Arch. Intern. Med. 152(9), 1893–1899 (1992)

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Endocrinology and Metabolism Disease, Ege University Medical School, 35100, Izmir, Turkey

    Serap Baydur Sahin, S. Cetinkalp, M. Erdogan, F. Saygili, C. Yilmaz & A. G. Ozgen

  2. Department of Internal Medicine, Ege University Medical School, Izmir, Turkey

    U. Cavdar

  3. Department of Radiology, Ege University Medical School, Izmir, Turkey

    G. Duygulu

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  1. Serap Baydur Sahin
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  2. S. Cetinkalp
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  3. M. Erdogan
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Correspondence to Serap Baydur Sahin.

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Sahin, S.B., Cetinkalp, S., Erdogan, M. et al. Pituitary apoplexy in an adrenocorticotropin-producing pituitary macroadenoma. Endocr 38, 143–146 (2010). https://doi.org/10.1007/s12020-010-9367-8

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  • DOI: https://doi.org/10.1007/s12020-010-9367-8

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