Hostname: page-component-cd9895bd7-7cvxr Total loading time: 0 Render date: 2024-12-23T23:23:38.740Z Has data issue: false hasContentIssue false
  • English
  • Français

Pituitary apoplexy following endoscopic sinus surgery

Published online by Cambridge University Press:  25 November 2009

G Fyrmpas ,
J Constantinidis ,
N Foroglou  and
P Selviaridis
G Fyrmpas*
Affiliation:
Department of Otolaryngology Head and Neck Surgery, AHEPA Hospital, Aristotle University of Thessaloniki, Greece
J Constantinidis
Affiliation:
Department of Otolaryngology Head and Neck Surgery, AHEPA Hospital, Aristotle University of Thessaloniki, Greece
N Foroglou
Affiliation:
Department of Neurosurgery, AHEPA Hospital, Aristotle University of Thessaloniki, Greece
P Selviaridis
Affiliation:
Department of Neurosurgery, AHEPA Hospital, Aristotle University of Thessaloniki, Greece
*
Address for correspondence: Dr Georgios Fyrmpas, Department of Otolaryngology Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Kiriakidi 1, 546 36 Thessaloniki, Greece. Fax: 00302310994916 E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To highlight the possibility of pituitary apoplexy after functional endoscopic sinus surgery for elimination of sinonasal infection, an important preparatory step for safe trans-sphenoidal access to the pituitary fossa.

Case report:

A 67-year-old man with a known pituitary macroadenoma developed headache, diplopia and reduced vision after endoscopic middle meatal antrostomy and ethmoidectomy for rhinosinusitis with polyps. Magnetic resonance imaging showed pituitary haemorrhage. The patient underwent emergency endoscopic trans-sphenoidal resection of the tumour, with significant symptomatic improvement. Despite mild right eyelid ptosis and persistent diabetes insipidus, the patient resumed normal activities in a few weeks. To our knowledge, this is the first report of pituitary apoplexy after a nasal operation.

Conclusion:

Pituitary apoplexy is a rare and potentially life-threatening event in high risk patients with pituitary adenomas; it may occur spontaneously or after surgical procedures. Early, combined surgical intervention by rhinologists and neurosurgeons is recommended. The endoscopic trans-sphenoidal approach is a safe and effective technique for the acute management of pituitary apoplexy.

Keywords

Pituitary GlandParanasal SinusesEndoscopyComplications
Type
Clinical Records
Information
The Journal of Laryngology & Otology , Volume 124 , Issue 6 , June 2010 , pp. 677 - 679
Copyright
Copyright © JLO (1984) Limited 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1 Joshi, SM, Cudlip, S. Transsphenoidal surgery. Pituitary 2008;11:353–60CrossRefGoogle ScholarPubMed
2 Lubbe, D, Semple, P. Pre-operative assessment of patients undergoing endoscopic, transnasal, transsphenoidal pituitary surgery. J Laryngol Otol 2007;122:644–6CrossRefGoogle ScholarPubMed
3 Randeva, HS, Schoebel, J, Byrne, J, Esiri, M, Adams, CB, Wass, JA. Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol (Oxf) 1999;51:181–8CrossRefGoogle ScholarPubMed
4 Biousse, V, Newman, NJ, Oyesiku, NM. Precipitating factors in pituitary apoplexy. J Neurol Neurosurg Psychiatry 2001;71:542–5CrossRefGoogle ScholarPubMed
5 Gransden, WR, Wickstead, M, Eykyn, SJ. Meningitis after trans-sphenoidal excision of pituitary tumours. J Laryngol Otol 1988;102:33–6CrossRefGoogle ScholarPubMed
6 Liu, JK, Weiss, MH, Couldwell, WT. Surgical approaches to pituitary tumors. Neurosurg Clin N Am 2003;14:93–107CrossRefGoogle ScholarPubMed
7 Nasseri, SS, Kasperbauer, JL, Strome, SE, McCaffrey, TV, Atkinson, JL, Meyer, FB. Endoscopic transnasal pituitary surgery: report on 180 cases. Am J Rhinol 2001;15:281–7CrossRefGoogle ScholarPubMed
8 Dusick, JR, Esposito, F, Mattozo, CA, Chaloner, C, McArthur, DL, Kelly, DF. Endonasal transsphenoidal surgery: the patient's perspective – survey results from 259 patients. Surg Neurol 2006;65:332–41, 341–2CrossRefGoogle ScholarPubMed
9 Santos Rde, P, Zymberg, ST, Abucham Filho, JZ, Gregorio, LC, Weckx, LL. Endoscopic transnasal approach to sellar tumors. Rev Bras Otorrinolaringol (Engl Ed) 2007;73:463–75CrossRefGoogle ScholarPubMed
10 Semple, PL, Jane, JA Jr, Laws, ER Jr. Clinical relevance of precipitating factors in pituitary apoplexy. Neurosurgery 2007;61:956–61, 961–2CrossRefGoogle ScholarPubMed
11 Onesti, ST, Wisniewski, T, Post, KD. Clinical versus subclinical pituitary apoplexy: presentation, surgical management, and outcome in 21 patients. Neurosurgery 1990;26:980–6CrossRefGoogle ScholarPubMed
12 Ayuk, J, McGregor, EJ, Mitchell, RD, Gittoes, NJ. Acute management of pituitary apoplexy – surgery or conservative management? Clin Endocrinol (Oxf) 2004;61:747–52CrossRefGoogle ScholarPubMed
13 Zhang, X, Fei, Z, Zhang, W, Cao, WD, Liu, WP, Zhang, JN et al. Emergency transsphenoidal surgery for hemorrhagic pituitary adenomas. Surg Oncol 2007;16:115–20CrossRefGoogle ScholarPubMed