Pituitary Apoplexy: A Review of Clinical Presentation, Management and Outcome in 45 Cases
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Objective: To review clinical presentation, management and outcomes following different therapies in patients with pituitary apoplexy. Methods: Retrospective analysis of case-records of patients with classical pituitary apoplexy treated in our hospitals between 1983–2004. Results: Forty-five patients (28 men; mean age 49 years, range 16–72 years) were identified. Only 8 (18%) were known to have pituitary adenomas at presentation. Thirty-four (81%) patients had hypopituitarism at presentation. CT and MRI identified pituitary apoplexy in 28% and 91% cases, respectively. Twenty-seven (60%) patients underwent surgical decompression, whilst 18 (40%) were managed conservatively. Median time from presentation to surgery was 6 days (range 1–121 days). Patients with visual field defects were more likely than those without these signs to be managed surgically (p = 0.01). Complete or near-complete resolution occurred in 93% (13/14), 94% (15/16) and 93% (13/14) of the surgically treated patients with reduced visual acuity, visual field deficit and ocular palsy, respectively. All patients with reduced visual acuity (4/4), visual field deficit (4/4) and ocular palsy (8/8) in the conservative group had complete or near-complete recovery. Only 5 (19%) patients in the surgical group and 2 (11%) in the conservative group had normal pituitary function at follow up. One (4%) patient in the surgical group and 4 (22%) in the conservative group had a recurrence of pituitary adenoma. Conclusions: This large series suggests that the patients with classical pituitary apoplexy, who are without neuro-ophthalmic signs or exhibit mild and non-progressive signs, can be managed conservatively in the acute stage.
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- Pituitary Apoplexy: A Review of Clinical Presentation, Management and Outcome in 45 Cases
Volume 7, Issue 3 , pp 157-163
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- pituitary apoplexy
- pituitary adenoma
- visual loss
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- Author Affiliations
- 1. Department of Endocrinology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, U.K
- 2. Department of Endocrinology, The James Cook University Hospital, Middlesbrough, U.K
- 3. Department of Neurosurgery, The James Cook University Hospital, Middlesbrough, U.K
- 4. Departments of Otonasolaryngology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, U.K.
- 5. Department of Endocrinology, Diabetes & Vascular Medicine, Peninsula Medical School, Royal Devon & Exeter Hospital, Exeter, EX2 5DW, U.K