Abstract
The pituitary apoplexy is a clinical syndrome characterized with specific clinical findings due to hemorrhage or infarction of a pre-existing pituitary tumor. It is difficult to diagnose the patient in the absence of a pre-established history of pituitary disease.
The association of apoplexy and chronic renal failure is extremely rare in the literature. In this report, we presented a heamodialysis patient who suffered from chronic renal failure for 8 years, applied to our emergency department with acute headache, nausea, vomiting and depression in consciousness and diagnosed as pituitary apoplexy. The patient was treated with conservatively and died in 72 hours after her admission. The most important factor whether the treatment will be surgical or conservative is decided due to patient’s visual acuity alterations.
Chronic renal failure is a multisytem disease, and its detrimental effects are observed in central and peripheral nervous system. We thought that this unique association of the pituitary apoplexy and chronic renal failure causes dismal prognosis.
References
- 1. Conomy JP, Feruson JH, Brodkey JS, Mitsumoto H: Spontaneous infarction in pituitary tumors. Neurologic and therapeutic aspects. Neurology 1975;25:580-587
- 2. Reid RL, Quigley ME, Yen SSC: Pituitary apoplexy: a review. Arch Neurol 1985; 42:712-719
- 3. Das NK, Behari S, Banerji D. Pituitary apoplexy associated with acute cerebral infarct. J Clin Neurosci 2008;15:1418-1420
- 4. Russel SJ, Miller KK. Pituitary Apoplexy, In: Swearingen B, Biller BMK eds, Diagnosis and Management of Pituitary Disorders (Contemporary Endocrinology). Pa:Humana Press, 2008. p. 353-375
- 5. Verrees M, Arafah BM, Selman WR. Pituitary tumor apoplexy: characteristics, treatment, and outcomes. Neurosurg Focus 2004; 16: 1-6
- 6. Cardosa ER, Peterson EW. Pituitary apoplexy: a review. Neurosurgery 1984;14:363-387
- 7. Semple PL, Jane JA, Laws ER: Clinical relevance of precipitating factors in pituitary apoplexy. Neurosurgery 2007;61:956-962
- 8. Piotin M, Tampieri D, Rüfenacht A, Mohr G, Garant M, Del Carpio R, Robert F, Delavelle J, Melason D. The various MRI patterns of pituitary apoplexy. Eur Radiol 1999;9:918-923
- 9. Biousse V, Newman NJ, Oyesiku NM: Precipitating factors in pituitary apoplexy. J Neurol Neurosurg Psychiatry 2001; 71:542-545
- 10. De la Torre M, Alcazar R, Aguirre M, Ferreras I: The dialysis patient with headache and sudden hypotension: Consider pituitary apoplexy. Nephrol Dial Transp 1998;13: 787-788
Abstract
Pituiter apopleksi mevcut pituiter tümörün kanama veya enfarktüsüne bağlı spesifik klinik bulgularla karakterize bir klinik sendromdur. Bilinen pituiter hastalık hikayesi yokluğunda teşhisi zordur. Apopleksi ve kronik böbrek yetmezliği birlikteliği literatürde oldukça azdır.
Sunduğumuz olgu, 8 yıldır kronik böbrek yetmezliği sonucu diyaliz tedavisi görmekte olan hasta acil servise başağrısı, bulantı, kusma bilinçte kötüleşme şikayeti ile başvurarak pituiter apopleksi tanısı almıştır. Hasta konservatif olarak tedavi edilmiş ve 72 saat sonra exitus olmuştur.
Tedavinin cerrahi veya medikal olarak mı yapılacağı konusunda verilen kararda en önemli faktör görme keskinliğinin kaybıdır. Kronik böbrek yetmezliği multisistem bir hastalıktır ve zararlı etkileri santral ve periferik sinir sisteminde görülmektedir. Bize göre pituiter apopleksi ve kronik renal yetmezliğin bu nadir birlikteliği kötü pprognoza neden olmaktadır.
Dr. Giyas AYBERK,
Dr. Timur YILDIRIM,
Dr. Mehmet Faik ÖZVEREN,
Dr. Mehmet Oguz KILINÇASLAN’,
References
- 1. Conomy JP, Feruson JH, Brodkey JS, Mitsumoto H: Spontaneous infarction in pituitary tumors. Neurologic and therapeutic aspects. Neurology 1975;25:580-587
- 2. Reid RL, Quigley ME, Yen SSC: Pituitary apoplexy: a review. Arch Neurol 1985; 42:712-719
- 3. Das NK, Behari S, Banerji D. Pituitary apoplexy associated with acute cerebral infarct. J Clin Neurosci 2008;15:1418-1420
- 4. Russel SJ, Miller KK. Pituitary Apoplexy, In: Swearingen B, Biller BMK eds, Diagnosis and Management of Pituitary Disorders (Contemporary Endocrinology). Pa:Humana Press, 2008. p. 353-375
- 5. Verrees M, Arafah BM, Selman WR. Pituitary tumor apoplexy: characteristics, treatment, and outcomes. Neurosurg Focus 2004; 16: 1-6
- 6. Cardosa ER, Peterson EW. Pituitary apoplexy: a review. Neurosurgery 1984;14:363-387
- 7. Semple PL, Jane JA, Laws ER: Clinical relevance of precipitating factors in pituitary apoplexy. Neurosurgery 2007;61:956-962
- 8. Piotin M, Tampieri D, Rüfenacht A, Mohr G, Garant M, Del Carpio R, Robert F, Delavelle J, Melason D. The various MRI patterns of pituitary apoplexy. Eur Radiol 1999;9:918-923
- 9. Biousse V, Newman NJ, Oyesiku NM: Precipitating factors in pituitary apoplexy. J Neurol Neurosurg Psychiatry 2001; 71:542-545
- 10. De la Torre M, Alcazar R, Aguirre M, Ferreras I: The dialysis patient with headache and sudden hypotension: Consider pituitary apoplexy. Nephrol Dial Transp 1998;13: 787-788
Details
| Primary Language | Turkish |
|---|---|
| Subjects | Brain and Nerve Surgery (Neurosurgery) |
| Journal Section | Case Reports |
| Authors | |
| Publication Date | July 25, 2010 |
| Published in Issue | Year 2010 Volume: 4 Issue: 2 |
