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Aluyi-Osa G, Suleman A, Salati C, Spadea L, Gagliano C, Musa M, Zeppieri M. Multidisciplinary management of pituitary macroadenoma. World J Methodol 2025; 15:97694. [DOI: 10.5662/wjm.v15.i3.97694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 11/18/2024] [Accepted: 12/03/2024] [Indexed: 03/06/2025] Open
Abstract
BACKGROUND Pituitary macroadenomas represent a significant challenge in clinical management due to their variable presentations and complex treatment considerations. This manuscript explores the multidisciplinary approach to understanding and managing pituitary macroadenomas, integrating neurosurgery, endocrinology, radiology, and pathology perspectives.
AIM To summarize the literature on pituitary macroadenoma and outline the possible multidisciplinary approach in the diagnosis, management, and rehabilitation of individuals with pituitary adenomas, to add to already preexisting knowledge, in managing these cases enhancing better ocular and systemic outcomes.
METHODS A search was conducted on an online publication database (PubMed) using the term “pituitary adenoma” including all results published over twenty years (2004-2024). Results were sorted for relevance, language, and completeness.
RESULTS A total of 176 records were returned. The guidelines of the PRISMA 2020 statement were followed in this study. A total of 23 records were excluded due to being out of scope while a further 13 records were duplicates. Another 17 records were not available as full-length articles and were also excluded. The references of each included record was further searched for relevant publications. A total of 141 records were therefore used in this minireview.
CONCLUSION Pituitary macroadenomas pose substantial clinical challenges due to their size and potential for significant hormonal and neurological impact, modern therapeutic strategies offer effective management options. Early detection and comprehensive treatment are essential for optimizing patient outcomes and maintaining quality of life. Continued research and advancements in medical technology are likely to further enhance the management and prognosis of this condition in the future
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Affiliation(s)
- Gladness Aluyi-Osa
- Department of Ophthalmology, Africa Eye Laser Center, Km 7, Benin 300105, Nigeria
| | - Ayuba Suleman
- Department of Ophthalmology, Africa Eye Laser Center, Km 7, Benin 300105, Nigeria
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Leopoldo Spadea
- Eye Clinic, Policlinico Umberto I, "Sapienza" University of Rome, Rome 00142, Italy
| | - Caterina Gagliano
- Department of Medicine and Surgery, University of Enna "Kore", Enna 94100, Italy
- Mediterranean Foundation "G.B. Morgagni", 95125 Catania, Italy
| | - Mutali Musa
- Department of Ophthalmology, Africa Eye Laser Center, Km 7, Benin 300105, Nigeria
- Department of Optometry, University of Benin, Benin 300283, Nigeria
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
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Mastandrea K, Voica M, Tetlay M, Hasan F. Pituitary Apoplexy Secondary to Gonadotropin-Releasing Hormone Agonist for Breast Cancer. JCEM CASE REPORTS 2023; 1:luad069. [PMID: 37908581 PMCID: PMC10580572 DOI: 10.1210/jcemcr/luad069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Indexed: 11/02/2023]
Abstract
Pituitary apoplexy is a potentially fatal clinical condition that results from pituitary infarction due to ischemia or hemorrhage. We present a case of a 53-year-old female patient with a history of recurrent pituitary macroadenoma who presented with headache, blurry vision, nausea, vomiting, and photophobia after receiving a gonadotropin-releasing hormone (GnRH) agonist, leuprolide, as part of adjuvant endocrine therapy for breast cancer. Magnetic resonance imaging (MRI) confirmed the presence of pituitary apoplexy, and endocrine workup showed anterior hypopituitarism. The patient was managed conservatively and required glucocorticoid replacement. A repeat MRI after 3 months showed a partially empty sella. A review of the literature revealed that this case adds to the growing number of patients who present with headache, visual symptoms, and symptoms related to meningeal irritation after administration of GnRH agonists, with varying latency from treatment to symptom onset. Although there are other cases involving female patients or patients with known pituitary macroadenomas, to our knowledge, this is the first reported case of pituitary apoplexy in a patient receiving a GnRH agonist as an adjuvant for breast cancer. Physicians should be aware of this rare complication of GnRH agonist therapy in patients with a pituitary macroadenoma.
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Affiliation(s)
- Katherine Mastandrea
- Division of Endocrinology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA 15090, USA
| | - Mihail Voica
- Division of Endocrinology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA 15090, USA
| | - Maryam Tetlay
- Division of Endocrinology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA 15090, USA
| | - Farhad Hasan
- Division of Endocrinology, Department of Medicine, Allegheny General Hospital, Pittsburgh, PA 15090, USA
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Guarda FJ, Yu X, Shiraliyeva N, Haines MS, Bradbury M, Saylor PJ, Nachtigall LB. GnRH agonist-associated pituitary apoplexy: a case series and review of the literature. Pituitary 2021; 24:681-689. [PMID: 33835355 DOI: 10.1007/s11102-021-01143-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To examine the clinical presentation and longitudinal outcome of Pituitary Apoplexy (PA) after gonadotropin-releasing hormone agonist (GnRHa) in a series of patients and compare to prior reports. METHODS A retrospective chart review was performed on seven patients receiving GnRHa who developed PA. Prior reported cases were analyzed. RESULTS Six men (median age 72 years) with prostate cancer and one woman (aged 22 years) undergoing oocyte donation presented with PA between 1990 and 2020. Most presented with within 24 h of the first dose, but two developed PA 1 to 5 months after GnRHa initiation. The main clinical manifestations were headache (100%), nausea and vomiting (86%). While no patients had a previously known pituitary tumor, all had imaging demonstrating sellar mass and/or hemorrhage at presentation. Among those surgically treated (5/7), 80% (4/5) of patients had pathologic specimens that stained positive for gonadotropins; the remaining patient's pathologic specimen was necrotic. At the time of PA, the most common pituitary dysfunction was hypocortisolism. Central adrenal insufficiency and central hypothyroidism were reversible in a subset. Pituitary imaging remained stable. CONCLUSIONS This is the first report of a case series with PA after GnRHa administration with longitudinal follow-up. Although infrequent, PA can be life-threatening and should be suspected among patients receiving GnRHa, with or without a known pituitary adenoma, who develop acute headache, nausea and/or vomiting. Since hypopituitarism was reversible in a subset, ongoing pituitary function testing may be indicated.
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Affiliation(s)
- Francisco J Guarda
- Department of Endocrinology and Center for Translational Endocrinology (CETREN-UC), School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Pituitary Tumor Program. Red de Salud UC-CHRISTUS, Santiago, Chile
| | - Xiaoling Yu
- Neuroendocrine Unit, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, 100 Blossom Street, Cox140, Boston, MA, 02114, USA
| | - Naila Shiraliyeva
- Neuroendocrine Unit, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, 100 Blossom Street, Cox140, Boston, MA, 02114, USA
| | - Melanie S Haines
- Neuroendocrine Unit, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, 100 Blossom Street, Cox140, Boston, MA, 02114, USA
| | - Michael Bradbury
- Department of Ophthalmology, University of Massachusetts Medical Center, Worcester, MA, USA
| | - Philip J Saylor
- Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, MA, USA
| | - Lisa B Nachtigall
- Neuroendocrine Unit, Massachusetts General Hospital and Department of Medicine, Harvard Medical School, 100 Blossom Street, Cox140, Boston, MA, 02114, USA.
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Sun, MD Z, Cai, MD X, Li, MD Y, Shao, MD D, Jiang, PhD Z. Endoscopic Endonasal Transsphenoidal Approach for the Surgical Treatment of Pituitary Apoplexy and Clinical Outcomes. Technol Cancer Res Treat 2021; 20:15330338211043032. [PMID: 34486456 PMCID: PMC8422825 DOI: 10.1177/15330338211043032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Purpose: This study investigated the clinical manifestations, surgical method, and treatment outcomes of patients with pituitary apoplexy and evaluated the safety and effectiveness of the endoscopic endonasal transsphenoidal approach in the treatment of pituitary adenomas. Patients and methods: In this retrospective study, were analyzed the data of patients with symptomatic pituitary apoplexy who received surgical treatment by endoscopic endonasal transsphenoidal approach from January 2017 to June 2020 at the Department of Neurosurgery of the First Affiliated Hospital of Bengbu Medical College. Patients were followed up through outpatient visits and telephone interviews. Results: Data for 24 patients including 13 males and 11 females with an average age of 46.46 years were analyzed. Headache (83.33%) and visual disturbances (75.00%) were the most common preoperative manifestations. In the 24 patients, 21 (87.50%) tumors were completely removed and 3 (12.50%) were partly removed. Intractable headache improved in all patients over a mean follow-up time of 25.16 months, and postoperative improvement in visual acuity was achieved in 17 of 18 patients (94.44%) with vision defects. Four patients (16.67%) experienced transient urinary collapse after the operation. No intracranial infection, carotid artery injury, or death occurred. Conclusion: The endoscopic endonasal transsphenoidal approach is a safe and effective method for the treatment of pituitary apoplexy.
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Affiliation(s)
- Zhixiang Sun, MD
- The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Xintao Cai, MD
- The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Yu Li, MD
- The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Dongqi Shao, MD
- The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
| | - Zhiquan Jiang, PhD
- The First Affiliated Hospital of Bengbu Medical College, Bengbu, China
- Zhiquan Jiang, Department of Neurosurgery, First Affiliated Hospital of Bengbu Medical College, 287 Changhuai Road, Bengbu, Anhui 233004, China.
Email
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Comparative analysis of pituitary adenoma with and without apoplexy in pediatric and adolescent patients: a clinical series of 80 patients. Neurosurg Rev 2021; 45:491-498. [PMID: 33914243 DOI: 10.1007/s10143-021-01551-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 04/01/2021] [Accepted: 04/14/2021] [Indexed: 10/21/2022]
Abstract
Pituitary adenomas (PAs) have a low incidence in pediatric and adolescent patients, and their clinical characteristics remain unclear. As a severe complication of PA, apoplexy was investigated in young patients in the present study. Eighty patients younger than 20 years with PAs who underwent surgery were included and divided into an apoplexy group and non-apoplexy group. The clinical data of these two groups were statistically analyzed and compared. The study included 33 boys and 47 girls, with a mean age of 16.9 years. There were six (7.5%) adrenocorticotropic hormone-secreting, 13 (16.3%) growth hormone-secreting, 47 (58.7%) prolactin-secreting, and 14 (17.5%) non-functioning PAs. There were 34 (42.5%) patients in the apoplexy group and 46 (57.5%) patients in the non-apoplexy group. Pre-operatively, patients in the apoplexy group were more likely to have visual impairment (hazard ratio: 2.841, 95% confidence interval: 1.073-7.519; P = 0.033) and had poorer visual impairment scores than those in the non-apoplexy group (P = 0.027). Furthermore, a longer duration of symptoms before surgery was significantly correlated with a poorer visual outcome in the apoplexy group (R = - 1.204; P = 0.035). However, apoplexy was not associated with tumor type, tumor size, resection rate, or tumor recurrence. Tumor apoplexy is common in pediatric and adolescent patients with PAs and is associated with more severe preoperative visual deficits. Hence, the appropriate timing of surgical treatment may be important for rescuing visual function in young PA patients.
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