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Published on: August 11, 2015
Pituitary adenomas complicating cardiac surgery: summary and review of 11 cases
1Department of Cardiovascular Surgery, San Francisco Heart Institute, Seton Medical Center, Daly City, CA 94015, USA.
Insights
Pituitary apoplexy, a rare complication of cardiac surgery, presents with neurological deficits. Transsphenoidal hypophysectomy is the preferred treatment, offering a good prognosis.
Area of Science:
- Neurosurgery
- Endocrinology
- Cardiology
Background:
- Pituitary apoplexy is a rare but serious complication.
- Cardiac surgery may precipitate pituitary apoplexy.
- This condition requires prompt diagnosis and management.
Observation:
- Eleven cases of pituitary apoplexy associated with cardiac surgery were identified over 13 years.
- Male patients predominated (10:1 ratio).
- Symptoms included headache, altered mental status, cranial nerve palsies, visual deficits, and hemiparesis.
Findings:
- Diagnosis was confirmed using advanced imaging like CT and MRI.
- Initial treatment involved adrenocortical steroids.
- Eight patients treated with transsphenoidal hypophysectomy survived, while one who underwent craniotomy died.
- Seven of nine survivors had minimal or resolving neurological deficits.
Implications:
- Untreated pituitary apoplexy can be fatal.
- Transsphenoidal hypophysectomy is the preferred surgical intervention.
- This approach offers low perioperative mortality and favorable long-term outcomes for pituitary apoplexy post-cardiac surgery.
Abstract:
From the literature and our own experience, 11 cases of hemorrhage or infarction of a pituitary adenoma associated with cardiac surgery have been identified over a 13-year period. Males outnumbered females by 10 to 1. Symptoms observed were headache, lethargy, confusion, obtundation, unilateral ptosis, meiosis, and opthalmoplegia involving cranial nerves III, IV, and VI, visual field deficits, and hemiparesis. Diagnosis in most recent cases has been confirmed with computerized tomography or magnetic resonance imaging. All patients received adrenocortical steroid therapy initially. Eight patients underwent transsphenoidal hypophysectomy and all survived. One patient underwent decompression craniotomy and died. Intracranial surgery was deferred in 1 patient who survived and in another who died of a massive stroke. Residual neurological deficits were noted to be either absent, minimal, or resolving in 7 of the 9 patients who survived their initial hospitalization. While numerous mechanisms have been proposed to explain the hemorrhage and necrosis of a pituitary adenoma during heart surgery, no direct cause has been clearly identified. Surgical treatment is commonly necessary since untreated pituitary apoplexy is often fatal. Transsphenoidal hypophysectomy with decompression is the preferred method of treatment with a low perioperative mortality and fairly good long-term prognosis.
