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[Stress-induced pituitary apoplexy in 2 phases]
F Proust1, D Hannequin, F Bellow
1Service de Neurochirurgie, Hôpital Charles Nicolle, Rouen.
Neuro-Chirurgie
|January 1, 1995
Summary
Physical exertion can trigger pituitary apoplexy, a rare condition causing sudden hypophyseal hemorrhage or infarction. This case highlights the importance of recognizing this link for prompt diagnosis and management of pituitary apoplexy.
Area of Science:
- Neuroendocrinology
- Neurosurgery
Background:
- Pituitary apoplexy is a clinical syndrome characterized by sudden onset of severe headache, visual impairment, and ophthalmoplegia, usually associated with a pituitary adenoma.
- Physical exertion has been anecdotally linked to pituitary apoplexy, but the pathophysiological mechanisms remain unclear.
Observation:
- A 47-year-old male presented with headache and visual deficits after physical exertion (a foot-race).
- Clinical examination revealed bilateral cavernous sinus syndrome and bitemporal hemianopia.
- Imaging studies (CT and MRI) demonstrated an enlarged sella with an intrasellar mass and peripheral enhancement.
Findings:
- Transsphenoidal surgery revealed infarction of the anterior pituitary gland with peripheral scarring.
- Post-operative outcomes included visual recovery and the development of anterior hypophyseal insufficiency.
- Histopathological examination confirmed pituitary infarction.
Implications:
- This case underscores the potential role of physical exertion as a trigger for pituitary apoplexy.
- Early diagnosis and surgical decompression are crucial for managing pituitary apoplexy and preserving visual function.
- Further research into the pathophysiological mechanisms linking physical stress and pituitary apoplexy is warranted.