Clinical and Biochemical Characteristics of Apoplexy in a Pituitary Mass; Pituitary Adenoma VS Rathke's Cleft Cyst (RCC)

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: MON 88-111-Cushing's Disease & Non-Functioning Hypothalamus-Pituitary Tumors
Monday, June 17, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board MON-107
Ribal Al Aridi*1, Joumana T Chaiban1, Dima Abdelmannan2, Warren Selman3 and Baha M Arafah4
1University Hospitals Case Medical Center, Cleveland, OH, 2Louis Stokes Cleveland VA Medical Center, Cleveland, OH, 3University Hospitals, Case Medical Center, Cleveland, OH, 4Case Western Reserve Univ, Cleveland, OH
Background: We recently demonstrated the clinical characteristics of patients presenting with previously unrecognized entity: RCC apoplexy (1). In the current investigation, we compared the clinical and biochemical characteristics of patients with RCC apoplexy to those observed with PA apoplexy.

Methods: Records of consecutive patients who presented with a pituitary mass along with clinical and imaging features of apoplexy were reviewed. All had visual and histopathological confirmation of intrasellar hemorrhage at surgery. Pituitary function was evaluated before, during and after surgery. Glucocorticoids were administered to all patients at diagnosis but were withheld after surgery.

Results: Of the 248 with PA who had surgery, 21 (8.5%) presented with characteristic features of apoplexy. During the same time period, an additional 36 patients had surgery for resection of RCC and 13 of those (36%) had classical manifestations of apoplexy. Thus, an apoplectic event was more likely to be the initial presentation at surgery in patient with RCC (OR 6, P <0.001) than in those with PA. Predisposing factors (anticoagulation and cabergoline) were noted in 6/21 patients with PA and in 2/13 with RCC (p=NS). Age and gender distribution were similar in both groups of patients with apoplexy. In comparison to patients with PA apoplexy, those with RCC apoplexy had lower prevalence of cranial nerve palsies (2/11 VS 11/19, P 0.034 OR 6) but otherwise similar prevalence rates of severe headaches (9/12 VS 15/19), impaired visual acuity (5/11 VS 11/19), visual field defects (3/9 VS 6/12) and fatigue (3/6 VS 2/6). The prevalence rates of adrenal insufficiency, hypothyroidism, and hypogonadism at presentation were also similar in the two groups of patients with apoplexy and so were their serum prolactin levels. Recovery of pituitary function after surgical decompression was equally prevalent in the two groups.

Summary and conclusions: Over one third of patients with RCC who had surgery presented with clinical and biochemical features of apoplexy and with the exception of lower prevalence of cranial nerve palsies, these characteristics were similar to the apoplectic syndrome observed in patients with PA. Imaging characteristics of the two groups at presentation were similar. Recovery of pituitary function after surgery was equally observed in both groups. The close similarities in pituitary function at presentation and after surgery suggest common pathophysiological mechanism.

Rathke cleft cyst apoplexy: a newly characterized distinct clinical entity. Chaiban JT, Abdelmannan D, Cohen M, Selman WR, Arafah BM. J Neurosurg. 2011 Feb;114(2):318-24.

Nothing to Disclose: RA, JTC, DA, WS, BMA

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