Review Article

Acta Neurochirurgica

, Volume 152, Issue 5, pp 749-761

Pituitary apoplexy: an overview of 186 cases published during the last century

  • Mehmet TurgutAffiliated withDepartment of Neurosurgery, Adnan Menderes University HospitalCumhuriyet Mahallesi, Adnan Menderes Bulvarı Email author 
  • , Yelda ÖzsunarAffiliated withDepartment of Radiology, Adnan Menderes University Hospital
  • , Sema BaşakAffiliated withDepartment of Throat, Nose, and Ear, Adnan Menderes University Hospital
  • , Engin GüneyAffiliated withDepartment of Endocrinology, Adnan Menderes University Hospital
  • , Erkin KırAffiliated withDepartment of Ophthalmology, Adnan Menderes University Hospital
  • , İbrahim MeteoğluAffiliated withDepartment of Pathology, Adnan Menderes University Hospital

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Abstract

Background

Pituitary apoplexy is a rare and life-threatening complication occurring in 0.6–10.5% of all cases of pituitary adenomas. Although the association between pituitary apoplexy and visual dysfunction has been recognized for a long time, the optimal management of this problem still remains controversial. The purpose of this overview was to present the surgical experience by analyzing the literature on the management of pituitary apoplexy for better treatment of these cases.

Materials and method

To establish a new guideline for the surgical treatment of this entity, publications reported during the last century and databases containing medical literature were analyzed. In addition, an illustrative case with pituitary apoplexy presenting with complaints of sudden onset severe headache associated with nausea, vomiting, and a sudden loss of vision was described. In fact, the experience in our complicated patient prompted us to review the available literature on the management of pituitary apoplexy to date.

Conclusions

Based on an overview of 186 cases of apoplectic pituitary adenoma presenting with monocular or binocular blindness, we highlight the importance of correct diagnosis and an early, but not necessarily emergency, surgery within the first week of admission to optimize visual outcome of such patients. The illustrative case further exemplifies the value of close interaction between members of the management team for optimal outcome.

Keywords

Pituitary tumor Endoscopy Pituitary apoplexy Transsphenoidal surgery Visual loss