SFEBES2021 Poster Presentations Neuroendocrinology and Pituitary (47 abstracts)
Retrospective audit of clinical, biochemical and radiological features of Pituitary apoplexy
Pratibha Machenahalli 1 , Amjad Shad 1 , Khalid Shrelala 1 , Puja Thandani 1 , Georgios Giovos 1 , Uzma Khan 1 , Tristan Page 1 , Faiza Haris 1 , Megan Smith 2 & Harpal Randeva 1
1University Hospitals Coventry and Warwickshire, Coventry, United Kingdom; 2UHCW, Coventry, United Kingdom
Background: Pituitary apoplexy is one of the rare endocrine emergencies. Most series indicate that incidence is between 2-7% based on clinical, surgical and histopathological evidence.1-3 Usually presents with severe headaches that may be associated with nausea vomiting, ocular palsies, fever, photophobia. Predisposing factors are pre-existing pituitary conditions, hypertension, major surgery, anticoagulation therapy, pregnancy, radiotherapy. Appropriate endocrine, radiological, visual fields assessment needs to be done to deliver adequate treatment.
Methods: Data was collected from the existing Pituitary MDT database, radiology and neurosurgical database using the “apoplexy, bleeding, methaemoglobin, haemorrhage and infarct” in the pituitary. We used the electronic patient record, radiology resources and patient case notes to collect the data. Data analysis done by using Microsoft excel. 36 patients were collected based on the radiological criteria. We collected information on demographics, predisposing factors, clinical features, radiological and biochemical investigations, treatment.
| MRI | 100 |
| Findings on MRI | |
| Normal | 8.3% (3/36) |
| Haemorrhage | 83.3% (33/36) |
| Infarction | 11.1% (4/36) |
| Microadenoma | 16.7% (6/36) |
| Macroadenoma | 66.7% (26/36) |
| Cavernous Sinus Invasion | 27.8% (11/36) |
| Optic Chiasm Compression 100% | 22.2% (9/36) |
| MRI | 100 |
| Findings on MRI | |
| Normal | 8.3% (3/36) |
| Haemorrhage | 83.3% (33/36) |
| Infarction | 11.1% (4/36) |
| Microadenoma | 16.7% (6/36) |
| Macroadenoma | 66.7% (26/36) |
| Cavernous Sinus Invasion | 27.8% (11/36) |
| Optic Chiasm Compression 100% | 22.2% (9/36) |
Results: Demographics-Male-16/36, female-19/36, age-21-90 years with median-59 years. 28/36 patients presented as apoplexy of this 21/36 presented as emergency and 41% incidental finding.
1. Previous history of pituitary disease 1/36 (30.6%) of thisNFPMA-26/36 (72.2%), Prolactinoma-3/36(8.3%), Acromegaly-1/36.
2. Presenting clinical features: Headache 86.6% (31/36), Vomiting 11/36, Fatigue 16/36, reduced labido 4/36, Visual Disturbance 7/36, Fever 2/36, Photophobia 4/36, Phonophobia 2/36. Abnormal Pupils 3/36, CN III Palsy 6/36, CN VI Palsy 4/36, CN III and VI Palsy 3/36.
3. Predisposing factors: Hypertension 15/36, Diabetes Mellitus /36, Intrapartum 0/36, Anti-Platelet Therapy 5/36, Dopamine Agonists 1/36, Radiotherapy 0
4. Biochemistry: a) Sodium-136.7+/-6 <125-3/36, 126 to 130-4/36, 131 to 135-3/36 >135-26/36 b) Pre-treatment cortisol: 401-677-3/36, 100-400-21/36, <100-10/36. (one patient was on Prednisolone) c) Prolactin-<100-6/36, 101-500-22/36, >500-10/36. d) FT4-<9pmol/l-6/34, >9 pmol/l-28/34 (4 patients didn’t get TFT’s measured at admission) e)Short Synacthen test post apoplexy: 18/33-Adequate response, 11/33-Inadequate response. (3 patients missed the follow ups)
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Endocrine Abstracts
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