Authors: Osamah J Choudhry Asad J Choudhry Elkin A Nunez Jean Anderson Eloy William T Couldwell Ivan S Ciric James K Liu
Publish Date: 2011/09/17
Volume: 15, Issue: 3, Pages: 428-435
Abstract
Pituitary apoplexy in patients with adrenocorticotropic hormone ACTH producing tumors is a rare occurrence We report four patients with Cushing’s disease harboring ACTHsecreting 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 ACTHsecreting 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 followup 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 nonapoplectic 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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