ArticleBrain circulation
Pituitary apoplexy in the setting of adrenocorticotropic hormone-secreting adenoma: A systematic review and illustrative case.
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Abstract
backgroundCushing's disease is a commonly described pathology in which an excess of adrenocorticotropic hormone (ACTH) is produced by a functional pituitary adenoma. Pituitary apoplexy is an even less common pathology that occurs due to acute hemorrhage or infarct of pituitary adenomas, more commonly in nonfunctional adenomas. Very rarely do these uncommon pathologies occur simultaneously in the same patient. We present an updated systematic review on presentation and management of apoplexy in the setting of ACTH-secreting adenoma, with an unusual case illustrating presentation and management of these complex concomitant pathologies.
methodsA systematic review was conducted in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, looking at literature discussing concomitant ACTH-producing adenoma and apoplexy.
resultsFifteen articles were included after reviewing 355 articles published from 1968-2024. Median age was 35 years. Majority of the patients (63.2%) were female. Visual acuity or visual field loss on presentation occurred in 12 (63.2%) and 7 (36.8%) patients. While 16 patients (84.2%) were treated with surgical intervention. The average follow up time was 16.7 months.
conclusionPituitary apoplexy in the setting of an ACTH-secreting adenoma is an infrequently encountered scenario that can present with a confounding clinical picture. Proper recognition and diagnosis are important as the proper preoperative clinical suspicion and diagnosis alters primary goals of surgical intervention.
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