Pituitary

, Volume 7, Issue 3, pp 157–163

Pituitary Apoplexy: A Review of Clinical Presentation, Management and Outcome in 45 Cases

Authors

  • Latika Sibal
    • Department of EndocrinologyNewcastle University Teaching Hospitals
  • Steve G. Ball
    • Department of EndocrinologyNewcastle University Teaching Hospitals
  • Vincent Connolly
    • Department of EndocrinologyThe James Cook University Hospital
  • Robert A. James
    • Department of EndocrinologyNewcastle University Teaching Hospitals
  • Philip Kane
    • Department of NeurosurgeryThe James Cook University Hospital
  • William F. Kelly
    • Department of EndocrinologyThe James Cook University Hospital
  • Pat Kendall-Taylor
    • Department of EndocrinologyNewcastle University Teaching Hospitals
  • David Mathias
    • Departments of OtonasolaryngologyNewcastle University Teaching Hospitals
  • Petros Perros
    • Department of EndocrinologyNewcastle University Teaching Hospitals
  • Richard Quinton
    • Department of EndocrinologyNewcastle University Teaching Hospitals
    • Department of EndocrinologyThe James Cook University Hospital
    • Department of Endocrinology, Diabetes & Vascular MedicinePeninsula Medical School, Royal Devon & Exeter Hospital
Article

DOI: 10.1007/s11102-005-1050-3

Cite this article as:
Sibal, L., Ball, S.G., Connolly, V. et al. Pituitary (2004) 7: 157. doi:10.1007/s11102-005-1050-3

Abstract

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.

Keywords

pituitary apoplexypituitary adenomahypopituitarismvisual loss

Copyright information

© Springer Science + Business Media, Inc. 2005