Conservative treatment cures an elderly pituitary apoplexy patient with oculomotor paralysis and optic nerve compression: a case report and systematic review of the literature

Yanghua Fan, Xinjie Bao, Renzhi Wang Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Background: Whether conservative treatment or surgical management is the most appropriate treatment for pitui...

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Autores principales:	Fan Y, Bao X, Wang R
Formato:	article
Lenguaje:	EN
Publicado:	Dove Medical Press 2018
Materias:	Pituitary apoplexy oculomotor paralysis conservative treatment Geriatrics RC952-954.6
Acceso en línea:	https://doaj.org/article/89f8980e343a4e0bbc585b36b70ddbbe
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spelling	oai:doaj.org-article:89f8980e343a4e0bbc585b36b70ddbbe2021-12-02T06:58:29ZConservative treatment cures an elderly pituitary apoplexy patient with oculomotor paralysis and optic nerve compression: a case report and systematic review of the literature1178-1998https://doaj.org/article/89f8980e343a4e0bbc585b36b70ddbbe2018-10-01T00:00:00Zhttps://www.dovepress.com/conservative-treatment-cures-an-elderly-pituitary-apoplexy-patient-wit-peer-reviewed-article-CIAhttps://doaj.org/toc/1178-1998Yanghua Fan, Xinjie Bao, Renzhi Wang Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Background: Whether conservative treatment or surgical management is the most appropriate treatment for pituitary apoplexy (PA) is controversial. In general, if severe symptoms of compression occur, such as oculomotor nerve palsy, neurosurgery is performed to relieve the compression of anatomical structures near the PA. Case description: We describe the case of a 79-year-old man who was found to have an intrasellar pituitary incidentaloma. The tumor was discovered accidentally, during an investigation into the cause of his dizziness. Two months later, he suddenly developed headaches, left ophthalmoplegia, decreased vision, severe blepharoptosis and diplopia. He was diagnosed with PA and hypocortisolemia based on magnetic resonance imaging (MRI) and blood tests, respectively. His symptoms of oculomotor palsy and optic nerve compression were serious, but his ophthalmological deficits were nonprogressive and his hormone levels improved through conservative treatment (hydrocortisone supplementation). Due to this older patient’s poor physical condition and serious coronary heart disease, after multidisciplinary consultation and according to his family’s wishes, we continued the conservative treatment and watched closely for any changes in the patient’s condition. After 6 months of conservative treatment, the patient’s symptoms of oculomotor nerve paralysis, pupil and vision defects completely disappeared, and no new complications occurred. Repeated MRI tests showed that the PA lesion gradually improved. The patient’s hypocortisolemia was completely relieved through oral supplementation with low-dose hydrocortisone. Conclusion: In older PA patients who have surgical contraindications, even with symptoms of compression, such as oculomotor nerve palsy, according to the international guidelines, if conservative treatment is effective and the condition is not progressing, it is possible to monitor patients’ condition closely and continue conservative treatment, which may yield good results. Keywords: pituitary apoplexy, oculomotor paralysis, conservative treatmentFan YBao XWang RDove Medical PressarticlePituitary apoplexyoculomotor paralysisconservative treatmentGeriatricsRC952-954.6ENClinical Interventions in Aging, Vol Volume 13, Pp 1981-1985 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	Pituitary apoplexy oculomotor paralysis conservative treatment Geriatrics RC952-954.6
spellingShingle	Pituitary apoplexy oculomotor paralysis conservative treatment Geriatrics RC952-954.6 Fan Y Bao X Wang R Conservative treatment cures an elderly pituitary apoplexy patient with oculomotor paralysis and optic nerve compression: a case report and systematic review of the literature
description	Yanghua Fan, Xinjie Bao, Renzhi Wang Department of Neurosurgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Background: Whether conservative treatment or surgical management is the most appropriate treatment for pituitary apoplexy (PA) is controversial. In general, if severe symptoms of compression occur, such as oculomotor nerve palsy, neurosurgery is performed to relieve the compression of anatomical structures near the PA. Case description: We describe the case of a 79-year-old man who was found to have an intrasellar pituitary incidentaloma. The tumor was discovered accidentally, during an investigation into the cause of his dizziness. Two months later, he suddenly developed headaches, left ophthalmoplegia, decreased vision, severe blepharoptosis and diplopia. He was diagnosed with PA and hypocortisolemia based on magnetic resonance imaging (MRI) and blood tests, respectively. His symptoms of oculomotor palsy and optic nerve compression were serious, but his ophthalmological deficits were nonprogressive and his hormone levels improved through conservative treatment (hydrocortisone supplementation). Due to this older patient’s poor physical condition and serious coronary heart disease, after multidisciplinary consultation and according to his family’s wishes, we continued the conservative treatment and watched closely for any changes in the patient’s condition. After 6 months of conservative treatment, the patient’s symptoms of oculomotor nerve paralysis, pupil and vision defects completely disappeared, and no new complications occurred. Repeated MRI tests showed that the PA lesion gradually improved. The patient’s hypocortisolemia was completely relieved through oral supplementation with low-dose hydrocortisone. Conclusion: In older PA patients who have surgical contraindications, even with symptoms of compression, such as oculomotor nerve palsy, according to the international guidelines, if conservative treatment is effective and the condition is not progressing, it is possible to monitor patients’ condition closely and continue conservative treatment, which may yield good results. Keywords: pituitary apoplexy, oculomotor paralysis, conservative treatment
format	article
author	Fan Y Bao X Wang R
author_facet	Fan Y Bao X Wang R
author_sort	Fan Y
title	Conservative treatment cures an elderly pituitary apoplexy patient with oculomotor paralysis and optic nerve compression: a case report and systematic review of the literature
title_short	Conservative treatment cures an elderly pituitary apoplexy patient with oculomotor paralysis and optic nerve compression: a case report and systematic review of the literature
title_full	Conservative treatment cures an elderly pituitary apoplexy patient with oculomotor paralysis and optic nerve compression: a case report and systematic review of the literature
title_fullStr	Conservative treatment cures an elderly pituitary apoplexy patient with oculomotor paralysis and optic nerve compression: a case report and systematic review of the literature
title_full_unstemmed	Conservative treatment cures an elderly pituitary apoplexy patient with oculomotor paralysis and optic nerve compression: a case report and systematic review of the literature
title_sort	conservative treatment cures an elderly pituitary apoplexy patient with oculomotor paralysis and optic nerve compression: a case report and systematic review of the literature
publisher	Dove Medical Press
publishDate	2018
url	https://doaj.org/article/89f8980e343a4e0bbc585b36b70ddbbe
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Conservative treatment cures an elderly pituitary apoplexy patient with oculomotor paralysis and optic nerve compression: a case report and systematic review of the literature

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