Authors: A Yoshino Y Katayama T Watanabe A Ogino T Ohta C Komine T Yokoyama T Fukushima H Hirota
Publish Date: 2007/04/30
Volume: 149, Issue: 6, Pages: 557-565
Abstract
Pituitary apoplexy occurs as a very rare complication of the pituitary function test We have experienced two cases of pituitary apoplexy following anterior pituitary function tests for preoperative assessment a triple bolus test and a TRH test To elucidate such a rare complication we outline our two cases and review 28 cases from the literature The clinical characteristics etiology pathophysiology and diagnostic and therapeutic implications are also discussed The combined data suggest that pituitary function tests have the potential to precipitate pituitary apoplexy and its manifestations range from a clinically benign event to a catastrophic presentation with permanent neurological deficits or even death although most patients may fortunately have a good outcome We suggest that the pituitary function test should not be done as a routine test and when such a test is planned the patient should be observed with caution for any symptomatic changes for at least 2 hours following the test for appropriate treatment Further MRI especially enhanced studies may provide an earlier diagnosis of the pituitary apoplexy since CT scan images often fail to demonstrate either density changes or obvious enlargement of the pituitary adenoma at the acute stage
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