Pituitary apoplexy secondary to dengue fever-induced-thrombocytopenia:A case report and review of literature

Rationale:Pituitary apoplexy(PA)is a rare endocrine emergency that requires prompt diagnosis and management.Dengue fever-induced-thrombocytopenia may rarely predispose to PA.Patient’s Concern:A 58-year-old male patient having known pituitary macroadenoma presented to the emergency department with fever,a sudden onset severe headache,and altered sensorium.Diagnosis:Pituitary apoplexy caused by dengue fever-induced-thrombocytopenia.Interventions:Conservative management with fluids,mannitol,dexamethasone and symptomatic treatment.Outcomes:The patient responded well to the treatment and was discharged uneventfully.Lessons:Although dengue hemorrhagic fever is a rare cause of pituitary apoplexy,it should be considered if a patient presents with headache and altered sensorium,and prompt initiation of treatment is crucial to prevent fatality and neuro-ophthalmic deficits.

Personalized Management of Chronic Myeloid Leukemia Presenting with Ovarian Apoplexy and Review of Health Emergency Cases

Introduction: Chronic myeloid leukemia (CML) may significantly affect quality of life and life expectancy in the accelerated and acute phases, especially if presented with health emergencies. Objective: The purpose of the study was the evaluation of the personalized management milestones in CML cases presented with ovarian apoplexy and the analysis of the international experience on health emergencies in this leukemia. Materials and Methods: An original, case-report study was performed. The diagnosis was confirmed by cytological, cytogenetic and molecular examinations of the peripheral blood and bone marrow at the comprehensive research cancer center— Institute of Oncology from Moldova. The real-time PCR was performed for quantitative detection of BCR-ABL gene p210 and p190 transcripts. The ECOG Scale and complete hematologic response (CR) estimated the short-term results. The ECOG performance status served as a measure of functional status. Its scores range from 0 to 5 and correlate with the level of patient functioning. CR is the disappearance of all detectable clinical and hematological signs of malignant neoplasm in response to treatment. CR span was assessed in months. The overall and relapse-free survivals asserted the long-term results of treatment, and were evaluated in months as a case. Results: CML may be manifested by life-threatening conditions, including infections and thrombotic events, splenic infarcts and ruptures, bleedings, etc. CML with the uncommon onset under the form of the ovarian apoplexy is described. The hematological CR was obtained under the treatment with imatinib mesylate. The molecular CR and the long-lasting overall survival (197.5 months) were achieved after the treatment with nilotinib. Under the treatment with tyrosine kinase inhibitors, the patient did not experience the disease burden and side effects, and resumed her work, with a good life quality (ECOG score is 0). Discussion: CML may be manifested by life-threatening health emergencies, especially thrombotic events, splenic infarcts and ruptures, bleedings, etc. The CML patients with high leukocyte and platelet counts may experience also different symptoms of hyperviscosity: tinnitus, priapism, stupor, visual abnormalities and cerebrovascular accidents. However, the management of CML with the life-threatening conditions, especially in the accelerated and acute phases, should be realized with participation of the multidisciplinary teams. Conclusions: The ovarian apoplexy may serve as a presenting feature of CML in young females with a highly elevated leukocyte count. The reported CML case underwent successful personalized management with 2 generations of tyrosine kinase inhibitors, even if designated with Socal intermediate-risk score and complicated by a health emergency.

The Observation of Pituitary Function in Patients with Acute Pituitary Apoplexy before and after Transsphenoidal Surgery

Objective： To explore the pituitary function of acute pituitary apoplexy and its effect by transsphenoidal surgery. Methods： The clinical data and endocrine hormones level of 25 patients with acute pituitary apoplexy who underwent transsphenoidal surgery from Jan. 2002 to June 2004 were retrospectively analyzed. Results： 13 cases underwent surgery within 3 days after admission and 22 cases within 1 week. Of the 25 cases, 9 patients suffered the impairment of pituitary-thyroidal function, 14 cases of pituitary-adrenal function and 11 cases of pituitary-gonadal function before surgery. After surgery, 5/9, 8/14 and 7/11 were recovered from the corresponding hypopituitarism. Conclusion： Hypopituitarism is a major manifestation of acute pituitary apoplexy. Urgent surgery decompression contributed to the improvement of pituitary function. Patients with hypopituitarism after surgery required the corresponding hormones replacement therapy.

COMMENTS ON THE THERAPEUTIC TIMETABLE OF ISCHEMIC APOPLEXY AND SUPER-EARLY INTERVENTION OF ACUPUNCTURE

According to the pathological process of ischemic apoplexy, which involves its onset and development, this paper expounds the great significance of adopting various active and effective measures within the therapeutic timetable for favorable prognosis and improvement of apoplexy. The author’s viewpoints differ from the conventional thinking towards the management of apoplexy, stressing super early intervention with acupuncture.

Pituitary Apoplexy: A MRI Finding Case and Literature Review

Introduction: Pituitary apoplexy is an ischemic or hemorrhagic rearrangement within a pituitary adenoma. Pituitary apoplexy is a rare disease that constitutes a diagnosis and therapeutic emergency. Most of the time, apoplexy is the manifestation inaugural of an adenoma unknown, but it can also complicate a known adenoma. All adenomas can be concerned with the occurrence of apoplexy, with an equivalent risk, whether they are secreting or not and whatever the type of secretion. We report the case of a patient in whom the cranio-encephalic MRI enabled to make the diagnosis. Observation: A 57-years-old woman abruptly presented severe cephalodynia, followed by a left visual field defect. The clinical examination revealed an alteration of the consciousness to the type of obstruction and a decrease in left visual acuity is 4/10th. The cranio-encephalic MRI performed revealed an expansive intrasellar process with suprasellar extension of heterogeneous signal on all the sequences performed alternating hemorrhagic stigmata in the central tumor zone suggesting a macroadenoma having bled, compatible with pituitary apoplexy. She received medical treatment and hormonotherapy, followed by surgical excision. The outcome was satisfactory. Conclusion: Pituitary apoplexy is a rare but serious complication of pituitary adenomas. It is responsible for various neuro-ophthalmologic. Pituitary apoplexy involves the patient’s functional and vital prognosis due to acute panhypopituitarism. It is a diagnostic and therapeutic emergency. MRI is a major contribution to diagnosis. Treatment is based on the combination of hormone replacement therapy and trans-sphenoidal tumor excision.

STUDY ON SCALP ELECTROACUPUNCTURE TREATMENT OF APOPLEXY AND ITS INFLUENCE ON HEMORHEOLOGY IN ISCHEMIC APOPLEXY PATIENTS

Objectives: To compare the therapeutic effect of scalp electroacupuncture with that of conventional body acupuncture for apoplexy (wind stroke) and to observe the influence of both acupuncture therapies on hemorheology of ischemic apoplexy.Methods: 183 patients, whose diseases are attributed to apoplexy according to the diagnostic criteria, are randomly divided into treatment group (93 cases) and control group (90 cases) and treated respectively with scalp electroacupuncture and conventional body acupuncture. 11 items of hemorheology of patients’ blood samples are tested with NXE-1 Viscometer which are taken in the early morning before and after treatment under fasting condition. Results: Both scalp electroacupuncture and conventional body acupuncture exert therapeutic effect for apoplexy, but the effect of scalp electroacupuncture is obviously better than that of conventional acupuncture (P< 0.05 ); both treatment group and control group are statistically significant in reducing plasma viscosity, high shear reduced viscosity, low shear reduced viscosity, erythrocyte sedimentation rate, hematocrit and fibrinogen, (P<0.01 and 0.05); while the treatment group is statistically significant in reducing whole blood viscosity, ratio of whole blood viscosity, erythrocyte index of rigidity and electrophoresis time of erythrocyte (P<0.01～ 0.05), but the control group is not significant statistically in influencing these indexes (P>0.05).

Clinical Observation on Treatment of Sequelae of Apoplexy With Eye and Body Acupuncture

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Clinical Observation on Acupuncture Treatment of 36 Cases of Pseudobutbar Paralysis Syndrome Caused by Apoplexy

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CLINICAL OBSERVATION ON THE TREATMENT OF APOPLEXY BY ACUPUNCTURE COMBINED WITH DRUGS

Apoplexy involves cerebrovascular accident, such as cerebral hemorrhage, cerebralthrombosis, cerebral infarction, subarachaoid hemorrhage, etc. and its sequelae in modern medicine. The author treated 81 cases of apoplexy using acupuncture combined with drugs. AIn0ng them, 36cases were male, accounting for 44%; 45 cases female, accounting for 56 %. The oldest was 82 yearsold, and youngest 28 years old. The shortest course of disease was one day, and the longest over 3years The treatment results show that 60 cases were cured, accounting for 74. 07%; 16 casesmarkedly effect, acc0unting for 19. 75 %; 3 cases improved, accounting for 3. 7 %; 2 cases ineffective,accounting for 2. 48 %. The total effect rate was 97. 52 %.

REVIEW AND PROSPECT OF THE TREATMENT OF APOPLEXY BY ACUPUNCTURE

By review of clinical reports on the treatment of apoplexy in the recent ten years, the authors analyse the main factors influencing the effect of treatment, and point out that for further improvement of the treatment effect of this disease, a strict design of the subject is needed, and it is necessary for the causes and pathogenesis of apoplexy to be analysed, so as to get a clear understanding of the relations among various factors affecting the effect of the treatment and the principal and subordinate position, then the best plan for treatment can only be selected.

ELONGATED-NEEDLE TREATMENT OF URINARY INCONTINENCE CAUSED BY APOPLEXY

In the present paper, the effect of deep insertion of elongated needle onto pelvic nerve(pelvic plexus) for treatment of 32 cases of urinary incontinence caused by apoplexy was observed andcompared to that of filiform needle group (25 cases). Results showed that the total effective rates ofthe elongated needle group and the filiform needle group were 96. 88 % and 68 % respectively, display-ing a significant difference (P【0.05) between the two groups. In addition, mechanisms of elongatedneedle in treatment of incontinence of urine were analyzed preliminarily.

Spontaneous pineal apoplexy in a pineal parenchymal tumor of intermediate differentiation

Pineal apoplexy is a rare clinical presentation of pineal parenchymal tumors. We report the curative treatment of a case of pineal parenchymal tumor of intermediate differentiation with spontaneous apoplectic hemorrhage. This case is shown through computed tomography and magnetic resonance imaging of the brain, and is confirmed via histopathological studies. Recurrent upward gaze paresis was observed after the stereotactic biopsy. The paresis required an expeditious tumor resection. The mechanism of the pineal apoplectic hemorrhage remains unclear although it has been observed in different pineal region lesions. Clinical and radiological evidence of the cure 5 years post-surgery is available.

COMPARATIVE ANALYSIS ON THERAPEUTIC EFFECTS OF APOPLEXY TREATED BY XINGNAO KAIQIAO ACUPUNCTURE METHOD AND WESTERN MEDICINE

The therapeutic effects of Xingnao Kaiqiao (醒脑开窍) acupuncture method and West-ern medicine treating apoplexy were compared in this paper. The results show that the total effectiverate is over 90. 00% in acupuncture group for treating motor dysfunction of limbs and main clinicalsymptotns, especially for treating paralysis of extremities, the total effective rate is up to 97. 72%,which is obviously better than that of Western medicine; moreover, the acupuncture has a special ef-fectiveness for restoring the function of cerebral tissue, and treating aphasia and central facial palsy.The characteristics of Xingnao Kaiqiao acupuncture method were described too.

CLINICAL INVESTIGATION ON TREATMENT OF ISCHEMIC APOPLEXY BY ACUPUNCTURE ALONG DU MERIDIAN

In the present study,245 patients suffering from lschemic apoplexy were dividedinto treatment group and control group.The 148 cases in the treatment group were punctured mainlyat points on the Du meridian and the other 97 cases in the control group were punctured on routineacupoints.It was noticed that 87.2％ of the cases in the treatment group and 52.6％ of the cases inthe control group were improved or cured by our treatment.The effective rate of the treatment groupwas 96.6％ and that of the control was 89.7％.There was a statistically significant difference in thetherapeutic effects between the two groups（P【0.05）.The blood rheological indexes were also examinedto study the mechanisms of this therapy primarily.

CLINICAL OBSERVATION ON 44 CASES OF APOPLEXY WITH ZHU'S SCALP ACUPUNCTURE

88 cases of apoplexy of recovering and sequela phases were divided randomly intotwo groups,group of Zhu’s Scalp Acupuncture and group of somatic acupuncture There were 44 Casesin each group.Clinical effect of Zhu’s Scalp Acupuncture was better than that of somatic acupuncture,percentage of basic cure and marked effect of the former was markedly higher than that of thelatter（P【0.05）.Clinical effect of Zhu’s Scalp Acupuncture on recovering phase of apoplexy wasmarkedly better than that on sequela phase（P【0.01 for the rate of basic cure and marked effect andP【0.05 for the total effective rate）.Clinical effect of Zhu’s Scalp Acupuncture on hemorrhagicapoplexy hadn’t marked difference with that on ischemic apoplexy（P】0.05）.Applying Zhu’s ScalpAcupuncture to treat apoplexy,only need a few points,it is easy to manipulate,the needling sensationsare intensive,the clinical effecct is good,it is easy to accept by patients.

CLINICAL OBSERVATION ON TREATMENT OF CEREBRAL APOPLEXY-INDUCED APHASIA BY ACUPUNCTURE

Acupuncture therapy was adopted in the present study to treat aphasia caused by cerebral apoplexy. Among the 24 patients in treatment group, 13 cases were cured, 6 were markedly improved, 4 improved and 1 ineffective. The total effective rate of this group was 95. 8%. Of the patients in the control group, 6 cases were cured, 5 markedly improved, 10 improved and 3 ineffective.The overall curative rate was 87. 5%. The therapeutic results of these two groups were statistically significantly different (P<0.05), the result of the treatment group superior to that of the control group. The obtained results indicate that the acupuncture therapy is an effective way for this illness.

Gonadotrophin-releasing hormone agonist-induced pituitary adenoma apoplexy and casual finding of a parathyroid carcinoma:A case report and review of literature

BACKGROUND Pituitary apoplexy represents one of the most serious,life threatening endocrine emergencies that requires immediate management.Gonadotropin-releasing hormone agonist(GnRHa)can induce pituitary apoplexy in those patients who have insidious pituitary adenoma coincidentally.CASE SUMMARY A 46-year-old woman,with a history of hypertension and menorrhagia was transferred to our hospital from a secondary care hospital after complaints of headache and vomiting,with loss of consciousness 5 min after an injection of GnRHa.The drug was prescribed by her gynecologist due to the presence of uterine myomas.The clinical neurological examination revealed right cranial nerve III palsy,ptosis and movement limitation of the right eye.Our first clinical consideration was a pituitary apoplexy.Blood hormonal analysis revealed mild hyperprolactinemia and high follicle stimulating hormone level;PTH and calcium was high with glomerular filtration rate mildly to moderately decrease.A computed tomography scan,revealed an enlarged pituitary gland(3.5 cm)impinging upon the optic chiasm with bone involvement of the sella.Following contrast media administration,the lesion showed homogeneous enhancement with high-density focus that suggests hemorrhagic infarction of the tumor.Transsphenoidal endoscopic surgery was perfomed and adenomatous tissue was removed.Immunohistochemistry was positive for luteinizing hormone(LH)and follicular-stimulating hormone(FSH).A solid hypoechoic nodule(14 mm x 13 mm x 16 mm)was found in the caudal portion of the right thyroid lobe after a parathyroid ultrasound.A genetic test of Multiple Endocrine Neoplasia type 1(MEN1)was negative.A right lower parathyroidectomy was performed and the pathologic study showed the presence of an encapsulated parathyroid carcinoma of 1.5 cm.A MEN type 4 genetic test was performed result was negative.CONCLUSION This case demonstrates an uncommon complication of GnRH agonist therapy in the setting of a pituitary macroadenoma and the casual finding of parathyroid carcinoma.It also highlights the importance of suspecting the presence of a multiple endocrine neoplasia syndrome and to carry out relevant genetic studies.

Clinical case discussions-Hypopituitarism and pituitary apoplexy caused by pituitary Adenomas

A case of“Hypopituitarism and pituitary apoplex induced by pituitary Adenomas”was collected in the Third Affiliated Hospital of Inner Mongolia medical University Geriatric Department.A rare and atypical disease as it is,delayed diagnosis and treatment is easily seen among those cases.Therefore,the paper aims to investigate the difference of clinical characteristics and treatment outcome of pituitary adenomas in elder patient through the case analysis.Clinically,patients with pituitary dysfunction may have life-threatening crisis so that timely diagnosis and aggressive treatment can be effective in reducing the pituitary crisis and reducing the misdiagnosis rate.

CLINICAL OBSERVATION ON APOPLEXY TREATED BY TRANSVERSE ACUPUNCTURE OF ANTERIOR OBLIQUE LINE OF VERTEX-TEMPORAL

cases of apoplexy were randomly divided into two groups: group A (40 cases)and group B (32 cases). In group A, we used transverse acupuncture of anteriorobligue line of vertextemporal plus acupuncture of commonlyused body acupoints for apoplexy. After 30 times of treatments, the results were as follows: In group A, basic recovery rate was 20%, marked improvement rate was 50%. In growp B, basic recovery rate was 9.4%, marked improvement rate was 25%. The total therapeutic effect in group A was better than that in group B.This indicated: Transverse acupuncture of anterioroblique line of vertextemporal has definite therapeutic effect for apoplexy and has better therapeutic effect than acupuncture along the line.