Tuesday, May 25, 2010

Pituitary apoplexy following endoscopic sinus surgery

The Journal of Laryngology & Otology (2010), 124:677-679 Cambridge University Press

Copyright © JLO (1984) Limited 2009

doi:10.1017/S0022215109991915

 

G Fyrmpasa1 c1, J Constantinidisa1, N Forogloua2 and P Selviaridisa2

a1 Department of Otolaryngology Head and Neck Surgery, AHEPA Hospital, Aristotle University of Thessaloniki, Greece

a2 Department of Neurosurgery, AHEPA Hospital, Aristotle University of Thessaloniki, Greece

 

Abstract

Objective: To highlight the possibility of pituitary apoplexy after functional endoscopic sinus surgery for elimination of sinonasal infection, an important preparatory step for safe trans-sphenoidal access to the pituitary fossa.

Case report: A 67-year-old man with a known pituitary macroadenoma developed headache, diplopia and reduced vision after endoscopic middle meatal antrostomy and ethmoidectomy for rhinosinusitis with polyps. Magnetic resonance imaging showed pituitary haemorrhage. The patient underwent emergency endoscopic trans-sphenoidal resection of the tumour, with significant symptomatic improvement. Despite mild right eyelid ptosis and persistent diabetes insipidus, the patient resumed normal activities in a few weeks. To our knowledge, this is the first report of pituitary apoplexy after a nasal operation.

Conclusion: Pituitary apoplexy is a rare and potentially life-threatening event in high risk patients with pituitary adenomas; it may occur spontaneously or after surgical procedures. Early, combined surgical intervention by rhinologists and neurosurgeons is recommended. The endoscopic trans-sphenoidal approach is a safe and effective technique for the acute management of pituitary apoplexy.

(Accepted July 15 2009)

(Online publication November 25 2009)

Key words: Pituitary Gland; Paranasal Sinuses; Endoscopy; Complications

Correspondence:

c1 Address for correspondence: Dr Georgios Fyrmpas, Department of Otolaryngology Head and Neck Surgery, Aristotle University of Thessaloniki, AHEPA Hospital, Kiriakidi 1, 546 36 Thessaloniki, Greece. Fax: 00302310994916 E-mail: drfirbas@hotmail.com

Footnotes

Dr G Fyrmpas takes responsibility for the integrity of the content of the paper.

Competing interests: None declared

From http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7779868