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Case Reports
. 2008 May;43(5):246-9.
doi: 10.3340/jkns.2008.43.5.246. Epub 2008 May 20.

Pituitary Apoplexy due to Pituitary Adenoma Infarction

Joo Pyung Kim  1 , Bong Jin Park, Sung Bum Kim, Young Jin Lim
Affiliations
Case Reports

Pituitary Apoplexy due to Pituitary Adenoma Infarction

Joo Pyung Kim et al. J Korean Neurosurg Soc. 2008 May.

Abstract

Cause of pituitary apoplexy has been known as hemorrhage, hemorrhagic infarction or infarction of pituitary adenoma or adjacent tissues of pituitary gland. However, pituitary apoplexy caused by pure infarction of pituitary adenoma has been rarely reported. Here, we present the two cases pituitary apoplexies caused by pituitary adenoma infarction that were confirmed by transsphenoidal approach (TSA) and pathologic reports. Pathologic report of first case revealed total tumor infarction of a nonfunctioning pituitary macroadenoma and second case partial tumor infarction of ACTH secreting pituitary macroadenoma. Patients with pituitary apoplexy which was caused by pituitary adenoma infarction unrelated to hemorrhage or hemorrhagic infarction showed good response to TSA treatment. Further study on the predisposing factors of pituitary apoplexy and the mechanism of infarction in pituitary adenoma is necessary.

Keywords: Pituitary adenoma infarction; Pituitary apoplexy.

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Figures

Fig. 1
Fig. 1
The preoperative sella magnetic resonance findings, the 3.1 × 2.3 × 2.2 cm-sized mass lesion is observed in sella and suprasella. The mass showing iso-signal intensity and peripheral high signal intensity in T1 weighted image that is compressing optic chiasm. Low signal intensity and peripheral rim enhancement without contrast enhancement in the central part are shown in Gadolinium enhancement (Gd-enhancement).
Fig. 2
Fig. 2
No evidence of remaining enhancing tumor or hemorrhage seen in postoperative first day follow up sella MRI. The microscopic examination shows total infarction without viable tumor cell. The cells are demonstrated as pale appearance maintaining a cell architecture (H&E, ×40)(A,C) (×200)(B,D).
Fig. 3
Fig. 3
According to Sella magnetic resonance findings, the 2.9 × 2.5 × 2.0 cm-size mass lesion is observed in sella and suprasella. Tumer infarction shows as isosignal intensity and peripheral high signal intensity in T1 weighted image that is compressing the optic chiasm and right cavernous sinus. Also, low signal intensity and peripheral rim enhancement without contrast enhancement in the central part are shown in Gd-enhancement.
Fig. 4
Fig. 4
No evidence of remaining enhancing tumor or hemorrhage seen in postoperative 2 months follow up sella MRI. Histologic appearance of focal ischemic necrosis within the pituitary adenoma (H&E, ×40)(A,C) (×200)(B,D).
See this image and copyright information in PMC

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