Apoplexy in Previously Known Tumours
Pituitary apoplexy (haemorrhage or infarction) usually occurs in patients, who were not previously diagnosed to have pituitary adenomas. There are conflicting reports on the commonest types of tumour responsible for apoplexy. Some studies have shown predo
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Apoplexy in Previously Known Tumours Ranabir Salam and Manash P. Baruah
Contents
Abbreviations
5.1
Introduction..................................................
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5.2
Prevalence .....................................................
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5.3 5.3.1 5.3.2
Risk Factors for Pituitary Apoplexy .......... Tumour Type .................................................. Precipitating Factors ......................................
36 36 36
5.4
Resolution of Hormonal Hypersecretion Following Pituitary Apoplexy .......................................
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References .................................................................
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ACTH CRH Gd-DTPA GH GnRH MRI PRL TRH
5.1
R. Salam, MD, DM (*) Department of Medicine, Regional Institute of Medical Sciences, Singjamei, Chingamakha, Liwa Road, Imphal, Manipur 795008, India e-mail: [email protected] M.P. Baruah, MBBS, MD, DM Department of Endocrinology, Excel Center, Maya Ville, Batthakur Mill Road, Ulubari, Guwahati, Assam 781007, India e-mail: [email protected]
Adrenocorticotropic hormone Corticotropin hormone Gadolinium-diethylenetriaminepentaacetic acid Growth hormone Gonadotropin-releasing hormone Magnetic resonance imaging Prolactin Thyrotropin-releasing hormone
Introduction
Pituitary apoplexy (haemorrhage or infarction) usually occurs in patients who were not previously diagnosed to have pituitary adenomas. In many instances pituitary apoplexy is the initial presentation of pituitary adenoma. But there are several reports of pituitary apoplexy in patients who have been previously diagnosed to have pituitary adenomas (Pelkonen et al. 1978; Onesti et al. 1990; Bills et al. 1993; Bonicki et al. 1993; Randeva et al. 1999; Sibal et al. 2004; Imboden et al. 2005; Dubuisson et al. 2007; Semple et al. 2007; Leyer et al. 2011). The onset of apoplexy may vary according to tumour type. And apoplexy may occur after 0.5–18 years after the initial diagnosis of pituitary tumour (Randeva et al. 1999). Recurrence of pituitary apoplexy has also been reported after several years following the initial treatment (Wakai et al. 1981; Bills et al. 1993; Acikgoz et al. 2004; Dubuisson et al. 2007).
M. Turgut et al. (eds.), Pituitary Apoplexy, DOI 10.1007/978-3-642-38508-7_5, © Springer-Verlag Berlin Heidelberg 2014
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R. Salam and M.P. Baruah
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5.2
Prevalence
Several retrospective studies on pituitary apoplexy have reported the prevalence of pituitary apoplexy among those with known tumours range from 9 % to 33 % (Mohr and Hardy 1982; Onesti et al. 1990; Bills et al. 1993; Bonicki et al. 1993; Randeva et al. 1999; Sibal et al. 2004; Imboden et al. 2005; Nielsen et al. 2006; Dubuisson et al. 2007; Semple et al. 2007; Leyer et al. 2011). However, in a recent study only one case had a known pituitary tumour among 42 cases of pituitary apoplexy (MollerGoede et al. 2011). Prospective studies reported pituitary apoplexy in 9–23 % patients with clinically non-functioning pituitary adenomas (Arita et al. 2006; Chen et al. 2011).
itary adenoma. Among those, 3 were of Cu
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