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 »  Abstract
 »  Introduction
 »  Case report
 »  Result
 »  Discussion
 »  References

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Year : 2000  |  Volume : 48  |  Issue : 3  |  Page : 294-6

Spontaneous resolution of a non-functioning pituitary adenoma following an apoplexy.


Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Science and Technology, Trivandrum, 695011, India.

Correspondence Address:
Department of Neurosurgery, Sree Chitra Tirunal Institute of Medical Science and Technology, Trivandrum, 695011, India.

  »  Abstract

A rare case of non-functioning pituitary adenoma, which completely resolved following an apoplectic event without producing hypopituitarism, is described.

How to cite this article:
Kachhara R, Nair S, Gupta A K. Spontaneous resolution of a non-functioning pituitary adenoma following an apoplexy. Neurol India 2000;48:294


How to cite this URL:
Kachhara R, Nair S, Gupta A K. Spontaneous resolution of a non-functioning pituitary adenoma following an apoplexy. Neurol India [serial online] 2000 [cited 2020 Oct 20];48:294. Available from: https://www.neurologyindia.com/text.asp?2000/48/3/294/1514




   »   Introduction Top

The term pituitary apoplexy represents a complex series of clinical events occurring as a consequence of the fulminant expansion of a pituitary tumour by infarction, haemorrhage, or haemorrhagic infarction of the tumour and the adjacent pituitary tissue. The sequelae to pituitary apoplexy are extremely varied, ranging from spontaneous recovery to fatal outcome, and include spontaneous remission of endocrinopathy, hypopituitarism, development of empty sella, and fracture of the dorsum sellae. Patients harboring endocrinologically active adenomas (e.g. those associated with acromegaly and Cushing's disease) are at an increased risk for the development of the pituitary apoplexy.[1],[2],[3] In many instances, the apoplectiform insult constitutes the first conclusive evidence that a pituitary tumour is present.[4] Spontaneous remission of endocrinopathy following an apoplexy is known with endocrinologically active pituitary adenomas. Spontaneous remission of a nonfunctioning adenoma following an apoplexy is a rare occurrence. We report a rare case of endocrinologically inactive pituitary macroadenoma which completely resolved following an apoplexy without causing hypopituitarism.


   »   Case report Top

A 42 year old male was referred to our services with history of sudden onset of severe throbbing, global headache with vomitings two months back, which lasted for 2-3 days and was treated with analgesic medications at the referring hospital. These symptoms subsided over a period of one week. He did not have any history of visual loss, diplopia or altered sensorium. There was no history of symptoms pertaining to hyperfunction of pituitary adenoma. Neurological examination was unremarkable. A computed tomography (CT) scan revealed a hyperdense sellar-suprasellar mass, which was enhancing on contrast administration. There was no retro or parasellar extension [Figure. 1]. A magnetic resonance imaging (MRI) scan done six weeks later revealed complete resolution of pituitary adenoma [Figure. 2]. Hormonal assay, done to rule out pituitary hypofunction, revealed all hormones within normal limits.


   »   Discussion Top

Spontaneous remission of endocrinopathy following an apoplectic event is a well known phenomenon in cases with hormonally active pituitary adenomas.[1],[3],[5],[6] Non functioning pituitary adenomas resolving completely following an apoplexy are rare.[7] Most cases cited involve large tumours or have features of Cushing's syndrome, or acromegaly.[1],[5],[6],[8] Pinto et al[9] described a case with apoplexy in a prolactin secreting adenoma causing resolution of adenoma leading to hypopituitarism. Although most cases occur spontaneously, there are some apparent predisposing factors such as bromocriptine therapy,[9] arteriography[10] and gadolinium administration.[11] It has also been reported after pituitary function tests.[12] Our patient had a clinically non-functioning adenoma which was recognized only after he presented as an apoplexy.
Classically, pituitary apoplexy is a condition of sudden onset, affecting large neoplasms and often associated with meningism, ophthalmoplegia and amourosis. Winer and Plant[13] reported sub acute onset of symptoms resembling meningoencephalitis followed by remission in two cases of endocrinologically inactive adenomas. Thompson et al[14] reported three cases of non apoplectic pituitary apoplexy where there was radiological and pathological evidence of vascular event in pituitary tumour and presented with ophthalmoplegia in absence of changes in either visual fields or acuity. Headache was a minor symptom. Hypopituitarism has been noted in some of the patients following remission after apoplexy.[1],[9],[10],[11] The present case never had any hypofunction of pituitary, following resolution of adenoma, and the apoplexy was the only manifestation of the tumour. Spontaneous regression of headache and vomitings suggests regression of the adenoma after spontaneous infarction. Lack of visual disturbances and altered sensorium in this particular case shows that it was comparatively a milder form of apoplexy. Complete regression of adenoma was documented on MRI after 6 weeks of apoplexy. This report adds to the spontaneous regression of adenoma following an apoplexy in an endocrinologically inactive adenoma without producing hypopituitarism.
 

  »   References Top

1.Gutin PH, Cushard WG, Wilson CB : Cushing's disease with pituitary apoplexy leading to hypopituitarism, empty sella, and spontaneous fracture of dorsum sellae. J Neurosurg 1979; 51 : 866-869.   Back to cited text no. 1    
2.Pelkonen R, Kuusisto A, Salmi J et al : Pituitary function after pituitary apoplexy. Am J Med1978; 65 : 773-778.   Back to cited text no. 2    
3.Rovit RL, Duane TD : Cushing's syndrome and pituitary tumours: pathophysiology and ocular manifestation of ACTH- secreting pituitary adenomas. Am J Med1969; 46 : 416-427.   Back to cited text no. 3    
4.Rovit RL, Fein JM : Pituitary apoplexy: A review and reappraisal. J Neurosurg1972; 37 : 280-288.   Back to cited text no. 4    
5.Tamasawa N, Kurahashi K, Baba T et al : Spontaneous remission of acromegaly after pituitary apoplexy following head trauma. J Endocrinological Invest1988; 11 : 429-432.   Back to cited text no. 5    
6.Carraro G, De Monti M, Galfelti F : Apoplexy in ACTH secreting pituitary adenoma. 'Spontaneous recovery' of secondary diabetes. Gazzetta - Medica - Italiana Archivio-per-le-Scienze -Mediche1997; 156 : 23-27.   Back to cited text no. 6    
7.Bhatoe HS : Remission in pituitary macroadenoma after apoplexy. Neurol India1993; 41 : 236-238.   Back to cited text no. 7    
8.Armstrong MR, Douek M, Schellinger D et al : Regression of pituitary apoplexy: CT and MR Studies. J Comp Assist Tomography 1991; 15 : 832-834.   Back to cited text no. 8    
9.Pinto G, Zerah M, Trivin C et al : Pituitary apoplexy in an adolescent with prolactin secreting adenoma. Hormonal Research1998; 50 : 38-41.  Back to cited text no. 9    
10.Louwerens M, de Herder WW, Postema PT et al : Pituitary insufficiency and regression of acromegaly caused by pituitary apoplexy following cerebral angiography. Euro J Endocrinology1996; 134 : 734-740.   Back to cited text no. 10    
11.Wichers M, Kristof RA, Springer W et al : Pituitary apoplexy with spontaneous cure of acromegaly and its possible relation to Gd-DTPA administration. Acta Neurochir (Wein) 1997; 139 : 992-994.   Back to cited text no. 11    
12.Masago A, Ueda Y, Kanai H et al : Pituitary apoplexy after pituitary adenoma after pituitary function test: A report of two cases and review of literature. Surg Neurol 1995; 43 : 158-165.   Back to cited text no. 12    
13.Winer JB, Plant G : Stuttering pituitary apoplexy resembling meningitis. J Neurol Neurosurg Psychiatry 1990; 53 : 440.   Back to cited text no. 13    
14.Thompson D, Powell M, Foster O : Atypical presentation of vascular events in pituitary tumours: 'non-apoplectic' pituitary apoplexy. J Neurol Neurosurg Psychiatry 1994; 57 : 1441-1442.   Back to cited text no. 14    

 

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