Pituitary apoplexy pathophysiology: Difference between revisions

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==Overview==
==Overview==
Pituitary [[apoplexy]] is an acute [[clinical]] [[syndrome]] caused by [[hemorrhage]] and [[necrosis]] in the [[pituitary gland]]. Most commonly [[pituitary apoplexy]] is associated with [[pituitary adenoma]]. The [[pituitary adenoma]] predisposes to an increased risk of [[bleeding]] within the [[pituitary gland]]. The [[pituitary adenoma]] has [[Fenestrated membrane|fenestrated]] [[endothelium]] surrounded by a variable number of [[smooth muscle cells]], which are not found in normal [[pituitary gland]].
Pituitary [[apoplexy]] is an acute [[clinical]] [[syndrome]] caused by [[hemorrhage]] and [[necrosis]] in the [[pituitary gland]]. Most commonly it is associated with [[pituitary adenoma]]. Pituitary adenoma has an increased risk of [[bleeding]] within the [[pituitary gland]]. The [[Pituitary adenoma]] has [[Fenestrated membrane|fenestrated]] [[endothelium]] surrounded by a variable number of [[smooth muscle cells]], which are not found in normal [[pituitary gland]].


==Pathophysiology==
==Pathophysiology==

Revision as of 15:44, 28 July 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]

Overview

Pituitary apoplexy is an acute clinical syndrome caused by hemorrhage and necrosis in the pituitary gland. Most commonly it is associated with pituitary adenoma. Pituitary adenoma has an increased risk of bleeding within the pituitary gland. The Pituitary adenoma has fenestrated endothelium surrounded by a variable number of smooth muscle cells, which are not found in normal pituitary gland.

Pathophysiology

Pituitary apoplexy is caused by bleeding into pituitary gland.

Genetics

Associated Conditions

Pituitary apoplexy is seen with 0.6 to 10% of pituitary adenomas.

Gross Pathology

  • The predominant finding is hemorrhage with or without necrosis.
  • Pale, necrotic material is particularly found when there is a long interval between the acute clinical event and surgery.

Microscopic Pathology

Electron microscopic shows evidence of abnormal fenestration of tumor vessels (pituitary adenoma) with fragmented basal membranes that may predispose to hemorrhage.

Histopathological image of nonfunctioning pituitary adenoma. Hematoxylin & eosin stain showing basophilic appearance of the cells.
Histopathological image of nonfunctioning pituitary adenoma. Hematoxylin & eosin stain showing basophilic appearance of the cells.

References

  1. Zayour DH, Selman WR, Arafah BM (2004). "Extreme elevation of intrasellar pressure in patients with pituitary tumor apoplexy: relation to pituitary function". J Clin Endocrinol Metab. 89 (11): 5649–54. doi:10.1210/jc.2004-0884. PMID 15531524.
  2. Oldfield EH, Merrill MJ (2015). "Apoplexy of pituitary adenomas: the perfect storm". J Neurosurg. 122 (6): 1444–9. doi:10.3171/2014.10.JNS141720. PMID 25859802.
  3. Schechter J (1972). "Ultrastructural changes in the capillary bed of human pituitary tumors". Am J Pathol. 67 (1): 109–26. PMC 2032586. PMID 5055626.
  4. Schechter J, Goldsmith P, Wilson C, Weiner R (1988). "Morphological evidence for the presence of arteries in human prolactinomas". J Clin Endocrinol Metab. 67 (4): 713–9. doi:10.1210/jcem-67-4-713. PMID 3417848.

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