Pituitary apoplexy natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, | If left untreated, pituitary apoplexy can be an [[Acute (medicine)|acute]] life threatening condition. Pituitary apoplexy may lead to a sudden decline in [[pituitary hormone]] production. The most life threatening [[endocrinopathy]] is an acute [[adrenal crisis]]. Complications of pituitary apoplexy include [[vision loss]], [[optic neuritis]], [[diplopia]], [[ptosis]], [[increased intracranial pressure]], [[hypothyroidism]], [[hypogonadism]], and [[growth hormone deficiency]]. The [[prognosis]] of pituitary apoplexy depends upon presentation and initiation of [[therapy]]. Emergent application of [[medical]] and surgical treatment is associated with greater improvement in [[Visual field defect|visual field defects]], [[visual acuity]], and [[diplopia]]. The outlook is good for people who are diagnosed early and treated. Patients require [[hormone]](s) replacement [[therapy]] for life. | ||
==Natural History== | ==Natural History== | ||
If left untreated, [[ | If left untreated, pituitary apoplexy features depend upon the size of [[hemorrhage]]. Pituitary apoplexy is an acute life threatening condition in case of massive [[hemorrhage]]. Pituitary apoplexy may lead to a sudden decline in [[pituitary hormone]] production. The most life threatening [[endocrinopathy]] is an acute [[adrenal crisis]]. In a case of small sized [[hemorrhage]], pituitary apoplexy may result in some temporary or permanent [[Endocrinopathy|endocrinopathies]] from hypofunction of the [[pituitary gland]].<ref name="pmid21082047">{{cite journal |vauthors=Woo HJ, Hwang JH, Hwang SK, Park YM |title=Clinical outcome of cranial neuropathy in patients with pituitary apoplexy |journal=J Korean Neurosurg Soc |volume=48 |issue=3 |pages=213–8 |year=2010 |pmid=21082047 |pmc=2966721 |doi=10.3340/jkns.2010.48.3.213 |url=}}</ref><ref name="BaruahRanabir2011">{{cite journal|last1=Baruah|first1=ManashP|last2=Ranabir|first2=Salam|title=Pituitary apoplexy|journal=Indian Journal of Endocrinology and Metabolism|volume=15|issue=7|year=2011|pages=188|issn=2230-8210|doi=10.4103/2230-8210.84862}}</ref> | ||
==Complications== | ==Complications== | ||
Complications of | Complications of pituitary apoplexy can include: | ||
* [[Adrenal crisis]] | * [[Adrenal crisis]] | ||
| Line 22: | Line 22: | ||
==Prognosis== | ==Prognosis== | ||
Acute | *Acute pituitary apoplexy can be life-threatening. | ||
*The [[mortality rate]] associated with pituitary apoplexy is 12.5% and without treatment, the mortality rate can reach as high as 50%. | |||
*Emergent application of [[medical]] and surgical treatment is associated with greater improvement in [[Visual field defect|visual field defects]], [[visual acuity]], and [[diplopia]]. | |||
*Prognosis is good for people who are diagnosed early and treated. Patients require [[hormone]](s) replacement [[therapy]] for [[life]].<ref name="pmid26221291">{{cite journal |vauthors=Xiao D, Wang S, Huang Y, Zhao L, Wei L, Ding C |title=Clinical analysis of infarction in pituitary adenoma |journal=Int J Clin Exp Med |volume=8 |issue=5 |pages=7477–86 |year=2015 |pmid=26221291 |pmc=4509236 |doi= |url=}}</ref><ref name="pmid18372348">{{cite journal |vauthors=Nawar RN, AbdelMannan D, Selman WR, Arafah BM |title=Pituitary tumor apoplexy: a review |journal=J Intensive Care Med |volume=23 |issue=2 |pages=75–90 |year=2008 |pmid=18372348 |doi=10.1177/0885066607312992 |url=}}</ref><ref name="pmid10468988">{{cite journal |vauthors=Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass JA |title=Classical pituitary apoplexy: clinical features, management and outcome |journal=Clin. Endocrinol. (Oxf) |volume=51 |issue=2 |pages=181–8 |year=1999 |pmid=10468988 |doi= |url=}}</ref><ref name="pmid19809320">{{cite journal |vauthors=Murad-Kejbou S, Eggenberger E |title=Pituitary apoplexy: evaluation, management, and prognosis |journal=Curr Opin Ophthalmol |volume=20 |issue=6 |pages=456–61 |year=2009 |pmid=19809320 |doi=10.1097/ICU.0b013e3283319061 |url=}}</ref> | |||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category:Endocrinology]] | [[Category:Endocrinology]] | ||
[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Medicine]] | |||
[[Category:Up-To-Date]] | |||
{{WH}} | {{WH}} | ||
{{WS}} | {{WS}} | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]
Overview
If left untreated, pituitary apoplexy can be an acute life threatening condition. Pituitary apoplexy may lead to a sudden decline in pituitary hormone production. The most life threatening endocrinopathy is an acute adrenal crisis. Complications of pituitary apoplexy include vision loss, optic neuritis, diplopia, ptosis, increased intracranial pressure, hypothyroidism, hypogonadism, and growth hormone deficiency. The prognosis of pituitary apoplexy depends upon presentation and initiation of therapy. Emergent application of medical and surgical treatment is associated with greater improvement in visual field defects, visual acuity, and diplopia. The outlook is good for people who are diagnosed early and treated. Patients require hormone(s) replacement therapy for life.
Natural History
If left untreated, pituitary apoplexy features depend upon the size of hemorrhage. Pituitary apoplexy is an acute life threatening condition in case of massive hemorrhage. Pituitary apoplexy may lead to a sudden decline in pituitary hormone production. The most life threatening endocrinopathy is an acute adrenal crisis. In a case of small sized hemorrhage, pituitary apoplexy may result in some temporary or permanent endocrinopathies from hypofunction of the pituitary gland.[1][2]
Complications
Complications of pituitary apoplexy can include:
- Adrenal crisis
- Vision loss and optic neuritis
- Diplopia
- Ptosis
- Increased intracranial pressure
- Hypothyroidism
- Hypogonadism
- Growth hormone deficiency
Prognosis
- Acute pituitary apoplexy can be life-threatening.
- The mortality rate associated with pituitary apoplexy is 12.5% and without treatment, the mortality rate can reach as high as 50%.
- Emergent application of medical and surgical treatment is associated with greater improvement in visual field defects, visual acuity, and diplopia.
- Prognosis is good for people who are diagnosed early and treated. Patients require hormone(s) replacement therapy for life.[3][4][5][6]
References
- ↑ Woo HJ, Hwang JH, Hwang SK, Park YM (2010). "Clinical outcome of cranial neuropathy in patients with pituitary apoplexy". J Korean Neurosurg Soc. 48 (3): 213–8. doi:10.3340/jkns.2010.48.3.213. PMC 2966721. PMID 21082047.
- ↑ Baruah, ManashP; Ranabir, Salam (2011). "Pituitary apoplexy". Indian Journal of Endocrinology and Metabolism. 15 (7): 188. doi:10.4103/2230-8210.84862. ISSN 2230-8210.
- ↑ Xiao D, Wang S, Huang Y, Zhao L, Wei L, Ding C (2015). "Clinical analysis of infarction in pituitary adenoma". Int J Clin Exp Med. 8 (5): 7477–86. PMC 4509236. PMID 26221291.
- ↑ Nawar RN, AbdelMannan D, Selman WR, Arafah BM (2008). "Pituitary tumor apoplexy: a review". J Intensive Care Med. 23 (2): 75–90. doi:10.1177/0885066607312992. PMID 18372348.
- ↑ Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass JA (1999). "Classical pituitary apoplexy: clinical features, management and outcome". Clin. Endocrinol. (Oxf). 51 (2): 181–8. PMID 10468988.
- ↑ Murad-Kejbou S, Eggenberger E (2009). "Pituitary apoplexy: evaluation, management, and prognosis". Curr Opin Ophthalmol. 20 (6): 456–61. doi:10.1097/ICU.0b013e3283319061. PMID 19809320.