Pituitary Apoplexy Following Endoscopic Retrograde Cholangiopancreatography

Celina Crisman, Max Ward, Neil Majmundar, Nitesh Damodara, Wayne D. Hsueh, Jean Anderson Eloy, James K. Liu

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)201-204
Number of pages4
JournalWorld Neurosurgery
Volume121
DOIs
StatePublished - Jan 2019

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Keywords

  • CO insufflation
  • ERCP
  • Endoscopic retrograde cholangiopancreatography
  • Laparoscopy
  • Pituitary apoplexy

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