Spontaneous Regression Of Non-functioning Pituitary Adenoma Due To Pituitary Apoplexy Following Anticoagulation Treatment - A Case Report And Review Of The Literature.
Zieliński, G., Witek, P., Koziarski, A., & Podgórski, J. (2013). spontaneous regression of non-functioning pituitary adenoma due to pituitary apoplexy following anticoagulation treatment - a case report and review of the literature. Endokrynologia Polska, 64(1), 54–58.
View Original Source →Abstract
Pituitary apoplexy (PA) is a rare, potentially life-threatening medical condition due to acute ischaemia or haemorrhage of the pituitary gland. The main clinical features are: abrupt onset of severe headache, nausea, vomiting, deteriorating level of consciousness, visual impairment and/or endocrine deficiency. Correct and prompt diagnosis is essential for effective therapy, but there are no randomised studies or strict recommendations defining treatment modalities. We present the case of a 59 year-old woman with pituitary tumour apoplexy, presenting with severe headache, vomiting and visual field deterioration. The patient was treated conservatively because of her refusal of surgery and was followed-up for five years. In the course of treatment, recovery of the visual field defects, as well as right sixth cranial nerve paresis, was observed. Repeated magnetic resonance imaging (MRI) revealed regression of the tumour without signs of its re-growth. We discuss therapeutic modalities with particular emphasis on morbidity and review the literature relating to the management of pituitary tumour apoplexy.
Case Details
Disease Location
Pituitary tumor apoplexy
Personal Characteristics
59-year-old post menopausal female, obese
Clinical Characteristics
A 59 year-old, postmenopausal woman was admitted to the hospital following an episode of severe headache, nausea, vomiting and dizziness of around two weeks’ duration prior to admission. The patient also had progressive visual impairment for the past six days. Six weeks prior to hospitalisation, deep vein thrombosis of the left lower extremity was diagnosed and a graded compression stocking and low molecular weight heparin (lmwh — fraxiparine 60 mg s.c. Daily) was initiated. P/e: decrease of visual acuity to 0.5 in both eyes, bilateral temporal field restriction, and diplopia. MRI confirmed pituitary tumor apoplexy. Hormones assessment: secondary adreanl insufficiency. Treated with hydrocortisone 200 mg i.v (t.i.d.), intravenous fluid replacement therapy and analgesia. Treated conservatively because of lack of consent for surgical intervention. Patient`s neurological state gradually and uneventfully improved. The visual abnormalities and right sixth cranial nerve paresis completely resolved. The patient was finally discharged on the 16th day of hospital stay on hydrocortisone replacement therapy. The next hormones assessment performed three months later revealed multihormonal insufficiency of the anterior pituitary. Levothyroxine supplementation at a dose of 50 μg/24 h was initiated, and hydrocortisone replacement therapy was continued. MRI of the pituitary performed three months later revealed no residual pituitary adenoma and a picture of secondary empty sella with slight displacement of the optic chiasm into the sella. The patient was followed-up in the outpatient clinic. MRI repeated five years after the incidence of pa showed no signs of tumour re-growth. A complete insufficiency of the anterior lobe of the pituitary was .confirmed, and continuous replacement therapy with hydrocortisone and levothyroxine was continued.
Remission Characteristics
Treated conservatively because of lack of consent for surgical intervention. Patient`s neurological state gradually and uneventfully improved. The visual abnormalities and right sixth cranial nerve paresis completely resolved. The patient was finally discharged on the 16th day of hospital stay on hydrocortisone replace- ment therapy. The next hormones assessment performed three months later revealed multihormonal insufficiency of the anterior pituitary. Levothyroxine supplementation at a dose of 50 μg/24 h was initiated, and hydrocortisone replacement therapy was continued. MRI of the pituitary performed three months later revealed no residual pituitary adenoma and a picture of secondary empatienty sella with slight displacement of the optic chiasm into the sella. The patient was followed-up in the outpatient clinic. MRI repeated five years after the incidence of pa showed no signs of tumour re-growth. A complete insufficiency of the anterior lobe of the pituitary was .confirmed, and continuous replacement therapy with hydrocortisone and levothyroxine was continued.
Treatment & Mechanisms
Proposed Remission Mechanisms
Not discussed
Clinical Treatment
Hormones replacement with steroids, levothyroxine.