Suspected Pituitary Apoplexy: Clinical Presentation, Diagnostic Imaging Findings and Outcome in 19 Dogs
Abstract
:1. Introduction
2. Materials and Methods
2.1. Inclusion and Exclusion Criteria
2.2. Clinical and Neurological Evaluation
2.3. Diagnostic Imaging Findings
2.4. Outcome
3. Results
3.1. Case Population
3.2. Onset of Clinical Signs
3.3. Neurological Findings
3.4. Imaging Findings
3.5. Treatment and Outcome
4. Discussion
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
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Signalment | Onset (Per-Acute/Acute/Chronic) | Main Complain | Epileptic Seizures | Accessory Signs |
---|---|---|---|---|
1. Mixed breed MN, 9.75 y, 24.6 Kg | Per-acute | Balance loss | No | \ |
2. Italian hound F, 11.5 y, 14.8 Kg | Per-acute | Balance loss | No | Pica |
3. Mixed breed FN, 12.7 y, 4.7 Kg | Per-acute | Balance loss | No | \ |
4. Italian Bracco dog F, 12.8 y, 27 Kg | Per-acute | Compulsion, circling, obtundation | No | \ |
5. Mixed breed FN, 12.7 y, 30 Kg | Per-acute | Vocalization, pathologic nystagmus | No | \ |
6. Beagle FN, 7.6 y, 16.6 Kg | Per-acute | Balance loss, pathologic nystagmus | No | \ |
7. Labrador Retriever F, 5 y, 31.2 Kg | Per-acute | Anxious behaviour | Yes | PU/PD, weakness |
8. Labrador Retriever FN, 10.8 y, 35 Kg | Per-acute | \ | Yes | \ |
9. Mixed breed FN, 5.8 y, 21 Kg | Chronic | Aggressive behaviour | No | \ |
10. Labrador Retriever FN, 8.6 y, 29 Kg | Per-acute | \ | Yes | \ |
11. Boxer FN, 11.4 y, 27.4 Kg | Per-acute | Vocalizations, circling | No | \ |
12. Springer Spaniel M, 13.7 y, 18.7 Kg | Acute | Disorientation, anxious behaviour, obtundation | Yes | \ |
13. Mixed breed M, 11.1 y, 33 Kg | Per-acute | Circling | No | Weight loss |
14. Mixed breed M, 9.8 y, 14.5 Kg | Per-acute | Disorientation, obtundation, balance loss | No | Tremors |
15. Corso dog FN, 9.4 y, 43 Kg | Per-acute | Balance loss | No | \ |
16. English Bulldog M, 6.1 y, 28 Kg | Per-acute | Aggressive behaviour, vocalization, obtundation | No | Dysorexia, tremors |
17. Mixed breed M, 9.3 y, 9.3 Kg | Chronic | Obtundation | No | Weakness, weight loss, tremors |
18. Mixed breed M, 3.2 y, 15 Kg | Per-acute | Non-specific changes from normal behaviour | Yes | \ |
19. Mixed breed M, 11.1 y, 27.6 Kg | Acute | Vocalization, obtundation | No | PU/PD |
Neurologic Examination | Behaviour | Mental Status | Posture | Gait | Postural Reactions | Cranial Nerves | Epileptic Seizures | Hyperalgesia |
---|---|---|---|---|---|---|---|---|
Results | Normal (n = 8) Altered (n = 11) | Normal (n = 12) Altered (n = 7) | Normal (n = 18) Altered (n =1) | Normal (n = 15) Altered (n = 4) | Normal (n = 14) Altered (n = 5) | Normal (n = 15) Altered (n =4) | No (n = 13) Yes (n = 6) | No (n = 16) Yes (n = 3) |
Detail | Disorientation (n = 6) Compulsion (n = 4) Circling (n = 3) Aggressive behaviour (n = 3) Head pressing (n = 2) Anxiety (n = 2) Vocalizations (n = 2) | Obtundation (n = 7) | Neck ventroflexion (n = 1) | Hindlimbs hypometria (n = 1) Hindlimbs proprioceptive ataxia (n = 1) Proprioceptive ataxia 4 limbs (n = 1) Tetraparesis (n = 1) | 4 limbs (n = 3) 1 posterior limb (n = 1) Left side (n = 1) | Altered menace response (n = 4) Internal ophtalmoparesis/plegia (n = 2) | Cervical (n = 2) Diffuse (n = 1) |
Signalment | Pre-Contrast Heterogeneity | Pre-Contrast Hyperattenuation | Hyperattenuating Foci | Contrast Enhancement | Post-Contrast Hypovascular Areas | CT Diagnosis |
---|---|---|---|---|---|---|
1. Mixed breed MN, 9.75 y, 24.6 Kg | Yes | Yes | Yes | Heterogeneous | Yes | Pituitary mass with intralesional haemorrhage |
3. Mixed breed FN, 12.7 y, 4.7 Kg | Yes | Yes | Yes | Heterogeneous | Yes | Pituitary mass with intralesional haemorrhage |
4. Italian Bracco dog F, 12.8 y, 27 Kg | Yes | Yes | Yes | Heterogeneous | Yes | Pituitary mass with intralesional haemorrhage |
5. Mixed breed FN, 12.7 y, 30 Kg | Yes | Yes | Yes | Heterogeneous | Yes | Pituitary mass with intralesional haemorrhage |
6. Beagle FN, 7.6 y, 16.6 Kg | Yes | Yes | Yes | Heterogeneous | Yes | Pituitary mass with intralesional haemorrhage |
7. Labrador Retriever F, 5 y, 31.2 Kg | Yes | Yes | Yes | Heterogeneous | No | Pituitary mass with intralesional haemorrhage |
8. Labrador Retriever FN, 10.8 y, 35 Kg | Yes | Yes | Yes | Heterogeneous | Yes | Pituitary mass with intralesional haemorrhage |
9. Mixed breed FN, 5.8 y, 21 Kg | Yes | Yes | Yes | Heterogeneous | Yes | Pituitary mass with intralesional haemorrhage |
10. Labrador Retriever FN, 8.6 y, 29 Kg | Yes | Yes | Yes | Heterogeneous | Yes | Pituitary mass with intralesional haemorrhage |
11. Boxer FN, 11.4 y, 27.4 Kg | Yes | Yes | No | Heterogeneous | No | Pituitary mass with intralesional haemorrhage |
12. Springer Spaniel M, 13.7 y, 18.7 Kg | Yes | Yes | No | Heterogeneous | Yes | Pituitary mass with intralesional haemorrhage |
13. Mixed breed M, 11.1 y, 33 Kg | Yes | Yes | No | Heterogeneous | Yes | Pituitary mass with intralesional haemorrhage |
14. Mixed breed M, 9.8 y, 14.5 Kg | Yes | Yes | No | Heterogeneous | Yes | Pituitary mass with intralesional haemorrhage |
15. Corso dog FN, 9.4 y, 43 Kg | Yes | Yes | Yes | Heterogeneous | No | Pituitary mass with intralesional haemorrhage |
16. English Bulldog M, 6.1 y, 28 Kg | Yes | Yes | No | Heterogeneous | Yes | Pituitary mass with intralesional haemorrhage and necrosis |
17. Mixed breed M, 9.3 y, 9.3 Kg | Yes | Yes | Yes | Heterogeneous | Yes | Pituitary mass with intralesional haemorrhage and necrosis |
18. Mixed breed M, 3.2 y, 15 Kg | Yes | Yes | Yes | Heterogeneous | Yes | Pituitary mass with intralesional haemorrhage and necrosis |
19. Mixed breed M, 11.1 y, 27.6 Kg | Yes | Yes | No | Heterogeneous | Yes | Pituitary mass with intralesional haemorrhage |
Signalment | T1-Weighted | T2-Weighted | FLAIR | T2*/SWI | DWI | ADC | Contrast Enhancement | MRI Diagnosis |
---|---|---|---|---|---|---|---|---|
1. Mixed breed MN, 9.75 y, 24.6 Kg | Homogeneous isointense | Heterogeneous isointense | Heterogeneous isointense | No | Hyperintense | Hypointense | Heterogeneous | Pituitary mass with different stages of intralesional haemorrhage |
2. Italian hound F, 11.5 y, 14.8 Kg | Heterogeneous isointense | Heterogeneous isointense | Heterogeneous isointense | Yes | Hyperintense | Hypointense | Heterogeneous | Pituitary mass with intralesional haemorrhage |
5. Mixed breed FN, 12.7 y, 30 Kg | Homogeneous isointense | Heterogeneous isointense | Heterogeneous isointense | Yes | Isointense | Isointense | Heterogeneous | Pituitary mass with intralesional haemorrhage |
6. Beagle FN, 7.6 y, 16.6 Kg | Heterogeneous hypointense | Heterogeneous hyperintense | Heterogeneous hyperintense | Yes | Hypointense | Hypointense | Heterogeneous | Pituitary mass with intralesional haemorrhage |
7. Labrador Retriever F, 5 y, 31.2 Kg | Heterogeneous hypointense | Heterogeneous hyperintense | Heterogeneous hyperintense | \ | Hypointense | Hyperintense | Heterogeneous | Pituitary mass with intralesional haemorrhage |
8. Labrador Retriever FN, 10.8 y, 35 Kg | Heterogeneous hypointense | Heterogeneous hyperintense | Heterogeneous hyperintense | No | \ | \ | Heterogeneous | Pituitary mass |
9. Mixed breed FN, 5.8 y, 21 Kg | Heterogeneous hypointense | Heterogeneous hyperintense | Heterogeneous hyperintense | Yes | \ | \ | Heterogeneous | Pituitary mass with intralesional haemorrhage |
11. Boxer FN, 11.4 y, 27.4 Kg | Homogeneous hyperintense | Heterogeneous hyperintense | Heterogeneous hyperintense | \ | \ | \ | Heterogeneous | Pituitary mass with intralesional haemorrhage |
12. Springer Spaniel M, 13.7 y, 18.7 Kg | Heterogeneous isointense | Heterogeneous hyperintense | Heterogeneous hyperintense | Yes | Hypointense | Hyperintense | Heterogeneous | Pituitary mass with intralesional haemorrhage |
Signalment | Onset (Per-Acute/Acute/Chronic) | Recovery Time | Long Term Follow-Up | MRI/CT | P:B Ratio | Mass Effect (Yes/No) |
---|---|---|---|---|---|---|
1. Mixed breed MN, 9.75 y, 24.6 Kg | Per-acute | <24 h | Alive (11 m) | MRI CT | 0.52 | No |
2. Italian hound F, 11.5 y, 14.8 Kg | Per-acute | <24 h | Alive (6 m) | MRI | 0.35 | No |
3. Mixed breed FN, 12.7 y, 4.7 Kg | Per-acute | <24 h | Alive (18 m) | CT | 0.75 | Yes |
4. Italian Bracco dog F, 12.8 y, 27 Kg | Per-acute | 48–72 h | Unrelated survival time: death 7 m | CT | 0.78 | Yes |
5. Mixed breed FN, 12.7 y, 30 Kg | Per-acute | <24 h | Alive (32 m) | MRI CT | 0.37 | No |
6. Beagle FN, 7.6 y, 16.6 Kg | Per-acute | 48–72 h | Related survival time: death 23 m | MRI CT | 0.48 | No |
7. Labrador Retriever F, 5 y, 31.2 Kg | Per-acute | <24 h | Alive (34 m) | MRI CT | 0.35 | No |
8. Labrador Retriever FN, 10.8 y, 35 Kg | Per-acute | D | Related death for cardiovascular arrest 3 days after PA diagnosis | MRI CT | 0.39 | No |
9. Mixed breed FN, 5.8 y, 21 Kg | Chronic | Persistent behavioural changes | Related survival time: death 8 m | MRI CT | 1.3 | Yes |
10. Labrador Retriever FN, 8.6 y, 29 Kg | Per-acute | <24 h | Unknown | CT | 0.33 | No |
11. Boxer FN, 11.4 y, 27.4 Kg | Per-acute | 24–48 h | Related survival time: death 1 m | MRI CT | 1.2 | yes |
12. Springer Spaniel M, 13.7 y, 18.7 Kg | Acute | <24 h | Unrelated survival time: death 25 m | MRI CT | 0.8 | Yes |
13. Mixed breed M, 11.1 y, 33 Kg | Per-acute | D | Euthanised 4 days after PA diagnosis | CT | 0.88 | Yes |
14. Mixed breed M, 9.8 y, 14.5 Kg | Per-acute | Unknown | Unknown | CT | 1.1 | Yes |
15. Corso dog FN, 9.4 y, 43 Kg | Per-acute | Unknown | Unknown | CT | 0.44 | No |
16. English Bulldog M, 6.1 y, 28 Kg | Acute | Unknown | Unknown | CT | 1.35 | Yes |
17. Mixed breed M, 9.3 y, 9.3 Kg | Chronic | 24–48 h | Related survival time: death 102 m | CT | 1.3 | Yes |
18. Mixed breed M, 3.2 y, 15 Kg | Per-acute | D | Euthanised 1 day after PA diagnosis | CT | 1.3 | Yes |
19. Mixed breed M, 11.1 y, 27.6 Kg | Acute | Unknown | Unknown | CT | 1.03 | Yes |
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Galli, G.; Bertolini, G.; Dalla Serra, G.; Menchetti, M. Suspected Pituitary Apoplexy: Clinical Presentation, Diagnostic Imaging Findings and Outcome in 19 Dogs. Vet. Sci. 2022, 9, 191. https://doi.org/10.3390/vetsci9040191
Galli G, Bertolini G, Dalla Serra G, Menchetti M. Suspected Pituitary Apoplexy: Clinical Presentation, Diagnostic Imaging Findings and Outcome in 19 Dogs. Veterinary Sciences. 2022; 9(4):191. https://doi.org/10.3390/vetsci9040191
Chicago/Turabian StyleGalli, Greta, Giovanna Bertolini, Giulia Dalla Serra, and Marika Menchetti. 2022. "Suspected Pituitary Apoplexy: Clinical Presentation, Diagnostic Imaging Findings and Outcome in 19 Dogs" Veterinary Sciences 9, no. 4: 191. https://doi.org/10.3390/vetsci9040191