Fatal Pituitary Tumor Apoplexy Presenting With Behavioral Disorder
Bibliographic record
Abstract
Pituitary apoplexy (PA) is a rare but potentially fatal ischemic or hemorrhagic phenomenon, with an annual incidence around 1.2 per million. It is often misdiagnosed because most patients have subclinical pituitary adenomas and its presentation can be confused with neurological or, very rarely, psychiatric processes. Here, we present a 31-year-old man, with history of hypertension and chronic renal disease on hemodialysis of unknown etiology, admitted in the Department of Psychiatry of our Hospital with altered behavioral symptoms. Neuroimaging studies showed an increase of the pituitary gland due to an intraparenchymatous lesion. He was found dead on his room floor. In the autopsy, we observed a pituitary increased in weight and size, which in sagittal section showed an extensive hemorrhagic area located in the anterior lobe. Histological examination revealed a 9 mm adrenocorticotrophic adenoma (ACTH-secreting adenoma), with an extensive intratumoral hemorrhage. PA is often a difficult diagnosis, since it can mimic other clinical situations. Clinicopathologic effects of PA are caused by a rapid increase in the size of the contents of the pituitary fossa and the subsequent rise of intrasellar pressure, with additional pressure on the hypothalamus and midbrain. This would possibly explain the alteration of vital functions and consciousness. Pituitary hemorrhage normally produces an acute stroke which causes characteristic symptoms; the extremely rare case that we present exemplifies how it may also have subclinical/insidiously course for days. To our knowledge, this is the first time to report that a so obvious macroscopic image of post-mortem pituitary with this rare disease. J Endocrinol Metab. 2016;6(4):129-131 doi: http://dx.doi.org/10.14740/jem363w
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.002 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.002 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.002 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".