Abdominal apoplexy

Two cases of the rare condition of abdominal apoplexy are described. The two main clincial presentations of this condition are discussed as is the aetiology. It is suggested that selective visceral angiography might prove helpful in preoperative diagnosis.     

Pituitary apoplexy and vasospasm

Two cases of pituitary apoplexy complicated by cerebral vasospasm are described. They emphasize the importance of angiography in the investigation of a protracted clinical course after pituitary apoplexy. The pathophysiology of postapoplectic vasospasm is discussed.     

Pituitary apoplexy following cholecystectomy

A case of pituitary apoplexy, which presented with hyperaesthesia in the distribution of the ophthalmic division of the left trigeminal nerve and a left sixth nerve palsy following cholecystectomy, is reported. Computed tomography and magnetic resonance imaging revealed a large intrasellar mass which extended laterally into the left cavernous sinus and showed evidence of old and recent haemorrhage within the tumour. This case demonstrates that patients who present with unusual neurological symptoms involving the cranial nerves after general anaesthesia, should undergo neurological and radiological investigations.     

Pituitary apoplexy: a review

The authors present a critical review of the literature on the hemorrhagic complications of pituitary adenomas, especially those leading to apoplexy. They emphasize the distinction between pituitary apoplexy, hemorrhages leading to sudden endocrine alterations, and asymptomatic hemorrhages. Moreover, they speculate upon the possible pathophysiology of pituitary apoplexy and its predisposing factors. The clinical presentation, natural history, radiological findings, and differential diagnosis are also discussed. Finally, the historical evolution of the treatment of pituitary apoplexy is reviewed, with emphasis on the surgical treatment.     

Intraventricular hemorrhage from pituitary apoplexy

The case of a patient with a massive intraventricular hemorrhage arising from a pituitary chromophobe adenoma is described. This rare and disastrous complication was ascribed to the large suprasellar extension of the tumor and its close proximity to the floor of the third ventricle. Hemorrhage in the tumor extended along the path of least resistance and ruptured into the third ventricle. A partially treated hyperviscosity syndrome and chemotherapy for an unrelated malignancy (multiple myeloma) may have predisposed the patient to the necrosis and hemorrhage in the pituitary tumor.     

Cerebral ischaemia in pituitary apoplexy

Pituitary apoplexy is a potentially fatal condition that can have serious consequences even after successful treatment. One of the potential complications of this syndrome is occlusion of the internal carotid arteries, which causes cerebral ischaemia. This can occur through one of two mechanisms—direct compression of the artery or vasospasm caused by factors released from haemorrhagic or necrotic material. We illustrate two examples of cerebral ischaemia with pituitary apoplexy, one with compression and one with vasospasm, both ending in a successful resolution. In both, magnetic resonance imaging, angiography, and hormonal studies allow diagnosis, and urgent surgical decompression should be the treatment of choice. We review the literature and discuss the mechanisms.     

Pituitary apoplexy after joint arthroplasty

Pituitary apoplexy is a rare but potentially life-threatening condition caused by the sudden enlargement of a pituitary adenoma secondary to infarction and hemorrhage. The clinical syndrome is characterized by sudden onset of headache, ocular palsies, visual disturbances, and altered state of consciousness. We report 2 patients who had postoperative pituitary apoplexy after total hip and total knee arthroplasty. Asymptomatic pituitary adenomas are difficult to diagnose preoperatively. Its existence is an unlikely suspect until the clinical symptoms develop after surgery. This is the first reported case following total hip arthroplasty.