P.130 Secondary trigeminal autonomic cephalgia due to pituitary adenomas: systematic search of the literature and case illustration

Abstract

Background: Trigeminal autonomic cephalgias (TAC) have been implicated in a multitude of intracranial mass lesions, including pituitary adenomas. Treatment of the associated pituitary adenoma has been reported to result in resolution of the secondary TAC. Methods: We conducted systematic search of the literature in accordance with PRISMA guidelines using Ovid Medline, Pubmed, Scopus, and Web of Science for TACs with associated pituitary lesions. We searched for all the relevant cases to detail the epidemiology, clinical phenotype of TAC, characteristics of the associated pituitary lesion including its hormonal profile, type of clinical intervention, and outcome. Results: Together with our case, 50 cases are reviewed. Prolactinomas were the most common hormone-producing adenomas (n=35; 71%). Few cases were non-functioning (n=3; 6%). Macroadenomas were predominant (n=30, 70%). Cavernous sinus extension was frequent (n=21; 54%). Medical intervention was the most employed form (n=31; 63%). Surgical intervention was carried in several cases (n=18; 37%). The success rate of medical management was high (n=25/31; 81%). Dopaminergic agonist therapy was the most common medical intervention (n=28; 90%). Conclusions: Secondary TACs with associated pituitary adenomas tend to have debilitating symptoms. The pathophysiology of the association is not entirely clear. Identifying the cause and employing the proper intervention is important to avoid unnecessary suffering.