Pituitary Apoplexy Following Endoscopic Retrograde Cholangiopancreatography

Authors

Celina Crisman, Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
Max Ward, Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
Neil Majmundar, Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
Nitesh Damodara, Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
Wayne D. Hsueh, Department of Otolaryngology, Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
Jean Anderson Eloy, Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA; Department of Otolaryngology, Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA.
James K. Liu, Department of Neurological Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA; Department of Otolaryngology, Head and Neck Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey, USA. Electronic address: james.liu.md@rutgers.edu.

Document Type

Article

Abstract

BACKGROUND: Pituitary apoplexy is an uncommon neurosurgical emergency that may be the initial presentation of undiagnosed pituitary adenomas. Though the exact pathogenesis is unclear, there appears to be an association between pituitary apoplexy and medical interventions that disturb the blood supply and venous drainage of the abnormal sellar region. We present the first case of pituitary apoplexy occurring after an endoscopic retrograde cholangiopancreatography (ERCP). CASE DESCRIPTION: A 43-year-old male who was several hours status post ERCP presented with a severe headache, bilateral ptosis, and multidirectional ophthalmoplegia. Computed tomography scan and magnetic resonance imaging of the brain revealed a hemorrhagic and necrotic sellar mass with suprasellar extension compressing the optic chiasm and bilateral extension displacing the cavernous carotid arteries laterally. The patient underwent emergent endoscopic endonasal transsphenoidal resection of the underlying pituitary tumor apoplexy with eventual resolution of his cranial nerve palsies. CONCLUSIONS: Although pituitary apoplexy has been recognized as a sequela of surgical and laparoscopic procedures, it should also be considered in less invasive gastrointestinal procedures which may alter the intraabdominal pressures, such as ERCP. Early detection of this unusual complication allows for rapid diagnosis and timely surgical intervention in select cases to prevent debilitating cranial nerve palsies, preserve visual function, and retain normal pituitary function.

Medical Subject Headings

Adenoma (diagnostic imaging, surgery); Adult; Cholangiopancreatography, Endoscopic Retrograde; Diagnosis, Differential; Humans; Male; Pituitary Apoplexy (diagnostic imaging, etiology); Pituitary Neoplasms (diagnostic imaging, surgery); Postoperative Complications (diagnostic imaging)

Publication Date

1-1-2019

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

121

First Page

201

Last Page

204

PubMed ID

30292038

Digital Object Identifier (DOI)

10.1016/j.wneu.2018.09.183

Recommended Citation

Crisman, Celina; Ward, Max; Majmundar, Neil; Damodara, Nitesh; Hsueh, Wayne D.; Eloy, Jean Anderson; and Liu, James K., "Pituitary Apoplexy Following Endoscopic Retrograde Cholangiopancreatography" (2019). Neurosurgery. 2220.
https://scholar.barrowneuro.org/neurosurgery/2220