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Latest revision as of 16:21, 18 October 2017

Pituitary apoplexy Microchapters

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Epidemiology and Demographics

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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, pituitary apoplexy is associated with pituitary adenoma. Pituitary adenoma predisposes the patient to an increased risk of bleeding within the pituitary gland. Pituitary adenoma has fenestrated endothelium surrounded by a variable number of smooth muscle cells which are not found in the normal pituitary gland, leading to increased susceptibility to pituitary apoplexy in these tumors. Pituitary apoplexy can result from a mutation in AIP gene which is a tumor suppressor gene located on chromosome 11q13.2. On gross pathology, pituitary apoplexy presents with hemorrhage with or without necrosis. Electron microscopy shows evidence of abnormal fenestration of tumor vessels (pituitary adenoma) with fragmented basal membranes that may predispose the patient to hemorrhage.

Pathophysiology

Pituitary apoplexy is caused by bleeding into the pituitary gland. Most often, pituitary apoplexy is seen with a pituitary adenoma. Pituitary adenoma predisposes the patient to an increased risk of bleeding within the pituitary gland.[1][2][3][4][5][6][7][8]

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 the patient 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. Source: By Jensflorian (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons

References

  1. Nielsen EH, Lindholm J, Bjerre P, Christiansen JS, Hagen C, Juul S, Jørgensen J, Kruse A, Laurberg P (2006). "Frequent occurrence of pituitary apoplexy in patients with non-functioning pituitary adenoma". Clin. Endocrinol. (Oxf). 64 (3): 319–22. doi:10.1111/j.1365-2265.2006.02463.x. PMID 16487443.
  2. Chacko AG, Chacko G, Seshadri MS, Chandy MJ (2002). "Hemorrhagic necrosis of pituitary adenomas". Neurol India. 50 (4): 490–3. PMID 12577104.
  3. 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.
  4. 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.
  5. Schechter J (1972). "Ultrastructural changes in the capillary bed of human pituitary tumors". Am J Pathol. 67 (1): 109–26. PMC 2032586. PMID 5055626.
  6. 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.
  7. Nawar RN, AbdelMannan D, Selman WR, Arafah BM (2008). "Pituitary tumor apoplexy: a review". J Intensive Care Med. 23 (2): 75–90. doi:10.1177/0885066607312992. PMID 18372348.
  8. Findling JW, Tyrrell JB, Aron DC, Fitzgerald PA, Wilson CB, Forsham PH (1981). "Silent pituitary apoplexy: subclinical infarction of an adrenocorticotropin-producing pituitary adenoma". J. Clin. Endocrinol. Metab. 52 (1): 95–7. doi:10.1210/jcem-52-1-95. PMID 6256408.

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