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Pituitary apoplexy following lumbar fusion surgery in prone position: A case report.

Abstract Pituitary apoplexy (PA) is a syndrome caused by acute hemorrhage or infarction of the pituitary gland, generally within a pituitary adenoma. PA following spinal surgery is a very rare complication and may be difficult to diagnose. However, early diagnosis of PA is essential for the timely treatment of pan-hypopituitarism and prevention of severe neurologic complications.
PMID
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Authors

Mayor MeshTerms

Postoperative Complications

Prone Position

Keywords
Journal Title medicine
Publication Year Start




PMID- 29742711
OWN - NLM
STAT- MEDLINE
DCOM- 20180516
LR  - 20180516
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 19
DP  - 2018 May
TI  - Pituitary apoplexy following lumbar fusion surgery in prone position: A case
      report.
PG  - e0676
LID - 10.1097/MD.0000000000010676 [doi]
AB  - RATIONALE: Pituitary apoplexy (PA) is a syndrome caused by acute hemorrhage or
      infarction of the pituitary gland, generally within a pituitary adenoma. PA
      following spinal surgery is a very rare complication and may be difficult to
      diagnose. However, early diagnosis of PA is essential for the timely treatment of
      pan-hypopituitarism and prevention of severe neurologic complications. PATIENT
      CONCERNS: A 73-year-old man had a posterior lumbar fusion surgery over a period
      of 8 hours on prone position. The patient complained of severe intractable
      headache accompanied by ophthalmalgia and ptosis on right eye 2 days after the
      surgery. DIAGNOSIS: Brain magnetic resonance imaging revealed a 1.3 x 2.6 x 2 cm 
      mass in the sellar fossa and suprasellar region and the laboratory tests
      indicated pan-hypopituitarism. INTERVENTIONS: High-dose intravenous steroid
      therapy and trans-sphenoidal hypophysectomy were performed. OUTCOMES:
      Pathological evaluation of the surgical specimen revealed a pituitary adenoma
      with total necrosis, indicating that the PA occurred because of tumor infarction.
      The patient recovered fully after resection of the pituitary adenoma and hormonal
      therapy. LESSONS: Even though the incidence is low, PA has been related to blood 
      pressure fluctuations or vasospasm during surgery. PA should be considered during
      differential diagnosis in cases of postoperative severe headache or ophthalmic
      complications.
FAU - Joo, Chunghee
AU  - Joo C
AD  - Department of Anesthesia and Pain Medicine, Incheon St. Mary's hospital, College 
      of Medicine, The Catholic University of Korea, Incheon, Republic of Korea.
FAU - Ha, Geol
AU  - Ha G
FAU - Jang, Yeon
AU  - Jang Y
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Adrenal Cortex Hormones)
SB  - AIM
SB  - IM
MH  - Adrenal Cortex Hormones/therapeutic use
MH  - Aged
MH  - Headache/etiology
MH  - Humans
MH  - Hypophysectomy
MH  - Infarction/complications
MH  - Lumbar Vertebrae/*surgery
MH  - Magnetic Resonance Imaging
MH  - Male
MH  - Ophthalmoplegia/etiology
MH  - Pituitary Apoplexy/diagnostic imaging/*etiology/therapy
MH  - Pituitary Neoplasms/blood supply
MH  - *Postoperative Complications/diagnostic imaging/therapy
MH  - *Prone Position
MH  - Spinal Fusion/*adverse effects
EDAT- 2018/05/10 06:00
MHDA- 2018/05/17 06:00
CRDT- 2018/05/10 06:00
PHST- 2018/05/10 06:00 [entrez]
PHST- 2018/05/10 06:00 [pubmed]
PHST- 2018/05/17 06:00 [medline]
AID - 10.1097/MD.0000000000010676 [doi]
AID - 00005792-201805110-00030 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 May;97(19):e0676. doi: 10.1097/MD.0000000000010676.