TY - JOUR
T1 - Clinical and imaging features of pituitary apoplexy and role of imaging in differentiation of clinical mimics
AU - Goyal, Pradeep
AU - Utz, Michael
AU - Gupta, Nishant
AU - Kumar, Yogesh
AU - Mangla, Manisha
AU - Gupta, Sonali
AU - Mangla, Rajiv
N1 - Publisher Copyright:
© 2018 Quantitative Imaging in Medicine and Surgery. All rights reserved.
PY - 2018/3/1
Y1 - 2018/3/1
N2 - To discuss the clinical syndrome, review common imaging findings of pituitary apoplexy (PA) and role of imaging in therapy and follow-up. Also, to review other acute clinical scenarios with similar clinical and/or imaging findings as PA. PA is a severe and potentially life-threatening medical emergency, characterized by constellation of symptoms/signs that occur as a result of acute hemorrhage and/or infarction in pituitary gland. Patients present with acute and sudden onset of symptoms/signs, most commonly with severe headache, vision deficits/ophthalmoplegia, altered mental status, and possible pan hypopituitarism. Pre-existing macro adenoma (65-90%), especially non-functioning and prolactinomas, are most susceptible to apoplexy, which undergoes hemorrhage or infarct, but PA can occur with normal pituitary or microadenoma. Because of the probable grave prognosis of PA, imaging characteristics of PA and other acute clinical scenarios with similar clinical and/or imaging findings should be familiar to radiologists. PA is potentially a life-threatening clinical syndrome, however, imaging and clinical findings can lead the radiologist towards appropriate diagnosis, and rule out other clinical mimics. When hemorrhage is secondary to an underlying lesion, regrowth of the pituitary tumor years after a PA episode is possible and patients require long-term clinical and imaging surveillance.
AB - To discuss the clinical syndrome, review common imaging findings of pituitary apoplexy (PA) and role of imaging in therapy and follow-up. Also, to review other acute clinical scenarios with similar clinical and/or imaging findings as PA. PA is a severe and potentially life-threatening medical emergency, characterized by constellation of symptoms/signs that occur as a result of acute hemorrhage and/or infarction in pituitary gland. Patients present with acute and sudden onset of symptoms/signs, most commonly with severe headache, vision deficits/ophthalmoplegia, altered mental status, and possible pan hypopituitarism. Pre-existing macro adenoma (65-90%), especially non-functioning and prolactinomas, are most susceptible to apoplexy, which undergoes hemorrhage or infarct, but PA can occur with normal pituitary or microadenoma. Because of the probable grave prognosis of PA, imaging characteristics of PA and other acute clinical scenarios with similar clinical and/or imaging findings should be familiar to radiologists. PA is potentially a life-threatening clinical syndrome, however, imaging and clinical findings can lead the radiologist towards appropriate diagnosis, and rule out other clinical mimics. When hemorrhage is secondary to an underlying lesion, regrowth of the pituitary tumor years after a PA episode is possible and patients require long-term clinical and imaging surveillance.
KW - Magnetic resonance imaging (MRI)
KW - Pituitary apoplexy (PA)
KW - Pituitary lesions
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U2 - 10.21037/qims.2018.03.08
DO - 10.21037/qims.2018.03.08
M3 - Review article
AN - SCOPUS:85044642498
SN - 2223-4292
VL - 8
SP - 219
EP - 231
JO - Quantitative Imaging in Medicine and Surgery
JF - Quantitative Imaging in Medicine and Surgery
IS - 2
ER -