Skip to main content
SpringerLink
Log in

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

  • Review Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ayuk J, McGregor EJ, Mitchell RD, Gittoes NJL (2004) Acute management of pituitary apoplexy—surgery or conservative management? Clin Endocrinol (Oxf) 61:747–752

    Article  Google Scholar 

  2. Bills D, Meyer F, Laws E, Davis DH, Ebersold M, Scheithauer BW, Ilstrup DM, Abboud CF (1993) A retrospective analysis of pituitary apoplexy. Neurosurgery 33:602–609

    Article  PubMed  CAS  Google Scholar 

  3. Cardosa ER, Peterson EW (1984) Pituitary apoplexy: a review. Neurosurgery 14:363–373

    Article  Google Scholar 

  4. Elsässer Imboden PN, De Tribolet N, Lobrinus A, Gaillard RC, Portmann L, Pralong F, Gomez F (2005) Apoplexy in pituitary macroadenoma: eight patients presenting in 12 months. Medicine (Baltimore) 84:188–196

    Article  Google Scholar 

  5. Mohr G, Hardy J (1982) Hemorrhage, necrosis, and apoplexy in pituitary adenomas. Surg Neurol 18:181–189

    Article  PubMed  CAS  Google Scholar 

  6. Onesti ST, Wisniewski T, Post KD (1990) Clinical versus subclinical pituitary apoplexy: presentation, surgical management, and outcome in 21 patients. Neurosurgery 26:980–986

    Article  PubMed  CAS  Google Scholar 

  7. Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CBT, Wass JAH (1999) Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol (Oxf) 51:181–188

    Article  CAS  Google Scholar 

  8. Semple P, Webb MK, de Villiers JC, Laws ER (2005) Pituitary apoplexy. Neurosurgery 56:65–73

    PubMed  Google Scholar 

  9. Cohen AR, Cooper PR, Kupersmith MJ, Flamm ES, Ransohoff J (1985) Visual recovery after transsphenoidal removal of pituitary adenomas. Neurosurgery 17:446–452

    Article  PubMed  CAS  Google Scholar 

  10. Maccagnan P, Macedo CLD, Kayath MJ, Nogueira RG, Abucham J (1995) Conservative management of pituitary apoplexy: a prospective study. J Clin Endocrinol Metab 80:2190–2197

    Article  PubMed  CAS  Google Scholar 

  11. McFadzean RM, Doyle D, Rampling R, Teasdale E, Teasdale G (1991) Pituitary apoplexy and its effect on vision. Neurosurgery 29:669–675

    Article  PubMed  CAS  Google Scholar 

  12. Post MJD, David NJ, Glaser JS, Safran A (1980) Pituitary apoplexy: diagnosis by computed tomography. Radiology 134:665–670

    PubMed  CAS  Google Scholar 

  13. Agrawal D, Mahapatra AK (2005) Visual outcome of blind eyes in pituitary apoplexy after transsphenoidal surgery: a series of 14 eyes. Surg Neurol 63:42–46

    Article  PubMed  Google Scholar 

  14. Chuang CC, Chang CN, Wei KC, Lao CC, Hsu PW, Huang YC, Chen YL, Lai LJ, Pai PC (2006) Surgical treatment of severe visual compromised patients after pituitary apoplexy. J Neurooncol 80:39–47

    Article  PubMed  Google Scholar 

  15. Goodman JM, Gilson M, Shapiro B (1973) Pituitary apoplexy—a cause of sudden blindness. J Indiana Sate Med Assoc 66:320–321

    CAS  Google Scholar 

  16. Henderson WR (1939) The pituitary adenomata—a follow-up study of the surgical results in 338 cases (Dr. Harvey Cushing’s series). Br J Surg 26:811–921

    Article  Google Scholar 

  17. Kaplan B, Day AL, Quisling R, Ballinger W (1983) Hemorrhage into pituitary adenomas. Surg Neurol 20:280–287

    Article  PubMed  CAS  Google Scholar 

  18. Laws ER Jr, Trautmann JC, Hollenhorst RW (1977) Transsphenoidal decompression of the optic nerve and chiasm. Visual results in 62 patients. J Neurosurg 46:717–722

    Article  PubMed  Google Scholar 

  19. McLarty DG, Kermali W, Makene WJ (1982) Pituitary tumours and blindness: continuation of the Pre-Harvey Cushing era in developing countries. Lancet 2:810–811

    Article  PubMed  CAS  Google Scholar 

  20. Muthukumar N, Rosette D, Soundaram M, Senthilbabu S, Badrinarayanan T (2008) Blindness following pituitary apoplexy: timing of surgery and neuro-ophthalmic outcome. J Clin Neurosci 15:873–879

    Article  PubMed  Google Scholar 

  21. Parent AD (1990) Visual recovery after blindness from pituitary apoplexy. Can J Neurol Sci 17:88–91

    PubMed  CAS  Google Scholar 

  22. Peter M, de Tribolet N (1995) Visual outcome after trans-sphenoidal surgery for pituitary adenomas. Br J Neurosurg 9:151–157

    Article  PubMed  CAS  Google Scholar 

  23. Robinson JL, Chir B (1972) Sudden blindness with pituitary tumors: report of three cases. J Neurosurg 36:83–85

    Article  PubMed  CAS  Google Scholar 

  24. Rovit RL, Fein JM (1972) Pituitary apoplexy: a review and reappraisal. J Neurosurg 37:280–288

    Article  PubMed  CAS  Google Scholar 

  25. Shenkin HA (1955) Relief of amblyopia in pituitary apoplexy by prompt surgical intervention. J Am Med Assoc 159:1622–1624

    PubMed  CAS  Google Scholar 

  26. Suri A, Narang KS, Sharma BS, Mahapatra AK (2008) Visual outcome after surgery in patients with suprasellar tumors and preoperative blindness. J Neurosurg 108:19–25

    Article  PubMed  Google Scholar 

  27. Symon L, Mohanty S (1982) Hemorrhage in pituitary tumours. Acta Neurochir (Wien) 65:41–49

    Article  CAS  Google Scholar 

  28. Waybright EA, Selhorst JB, Young HF, Harbison JW (1983) Tumors compressing the optic nerve: diagnosis and surgical results. Va Med 110:230–234

    PubMed  CAS  Google Scholar 

  29. Brougham M, Heusner AP, Adams RD (1950) Acute degenerative changes in adenomas of the pituitary body—with special reference to pituitary apoplexy. J Neurosurg 7:421–439

    Article  PubMed  CAS  Google Scholar 

  30. Nakahara K, Oka H, Utsuki S, Iida H, Kurita M, Mochizuki T, Fujii K (2006) Pituitary apoplexy manifesting as diffuse subarachnoid hemorrhage. Neurol Med Chir (Tokyo) 46:594–597

    Article  Google Scholar 

  31. Charalampaki P, Ayyad A, Kockro RA, Perneczky A (2009) Surgical complications after endoscopic transsphenoidal pituitary surgery. J Clin Neurosci 16:786–789

    Article  PubMed  Google Scholar 

  32. Sibal L, Ball SG, Connoly V, James RA, Kane P, Kelly WF, Kendall-Taylor P, Mathias D, Perros P, Quinton R, Vaidya B (2004) Pituitary apoplexy: a review of clinical presentation, management and outcome in 45 cases. Pituitary 7:157–163

    Article  PubMed  Google Scholar 

  33. Uihlein A, Balfour WM, Donovan PF (1957) Acute hemorrhage into pituitary adenomas. J Neurosurg 14:140–151

    Article  PubMed  CAS  Google Scholar 

  34. Locatelli M, Spagnoli D, Isalberti M, Branca V, Gaini SM, Lania A (2008) A potential catastrophic trap: an unusually presenting sellar lesion. Eur J Neurol 15:98–101

    PubMed  CAS  Google Scholar 

  35. Okawara M, Yamaguchi H, Hayashi S, Matsumoto Y, Inoue Y, Okwara S (2007) A case of ruptured carotid artery aneurysm mimicking pituitary apoplexy (in Japanase). No Shinkei Geka 35:1169–1174

    PubMed  Google Scholar 

  36. Romano A, Chibbaro S, Marsella M, Ippolito S, Benericetti E (2006) Carotid cavernous aneurysm presenting as pituitary apoplexy. J Clin Neurosci 13:476–479

    Article  PubMed  CAS  Google Scholar 

  37. Suzuki H, Muramatsu M, Murao K, Kawaguchi K, Shimizu T (2001) Pituitary apoplexy caused by ruptured internal carotid aneurysm. Stroke 32:567–569

    PubMed  CAS  Google Scholar 

  38. Iqbal J, Kanan I, Al Homsi M (1999) Non-neoplastic cystic lesions of the sellar region presentation, diagnosis and management of eight cases and review of the literature. Acta Neurochir (Wien) 141:389–397

    Article  CAS  Google Scholar 

  39. Griffith HB, Veerapen R (1987) A direct transnasal approach to the sphenoid sinus. Technical note. J Neurosurg 66:140–142

    Article  PubMed  CAS  Google Scholar 

  40. Jankowski R, Auque J, Simon C, Marchal JC, Hepner H, Wayoff M (1992) Endoscopic pituitary tumor surgery. Laryngoscope 102:198–202

    Article  PubMed  CAS  Google Scholar 

  41. Cavallo LM, Prevedello D, Esposito F, Laws ER Jr, Dusick JR, Messina A, Jane JA Jr, Kelly DF, Cappabianca P (2008) The role of the endoscope in the transsphenoidal management of cystic lesions of the sellar region. Neurosurg Rev 31:55–64

    Article  PubMed  Google Scholar 

  42. Jho HD, Carrau RL (1997) Endoscopic endonasal transsphenoidal surgery: experience with 50 patients. J Neurosurg 87:44–51

    Article  PubMed  CAS  Google Scholar 

  43. Pelkonen R, Kuusisto A, Salmi J, Eistola P, Raitta C, Karonen SL, Aro A (1978) Pituitary function after pituitary apoplexy. Am J Med 65:773–778

    Article  PubMed  CAS  Google Scholar 

  44. Nemergut EC, Zuo Z, Jane JA Jr, Laws ER Jr (2005) Predictors of diabetes insipidus after transsphenoidal surgery: a review of 881 patients. J Neurosurg 103:448–454

    Article  PubMed  Google Scholar 

  45. Maurer J, Hinni M, Mann W, Pfeiffer N (1999) Optic nerve decompression in trauma and tumor patients. Eur Arch Otorhinolaryngol 256:341–345

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

We wish to express our sincere thanks and appreciation to Dr. Mete Önde for his assistance during statistical analysis of the data.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Adnan Menderes University Hospital, 09100, Aydın, Turkey

    Mehmet Turgut

  2. Department of Radiology, Adnan Menderes University Hospital, 09100, Aydın, Turkey

    Yelda Özsunar

  3. Department of Throat, Nose, and Ear, Adnan Menderes University Hospital, 09100, Aydın, Turkey

    Sema Başak

  4. Department of Endocrinology, Adnan Menderes University Hospital, 09100, Aydın, Turkey

    Engin Güney

  5. Department of Ophthalmology, Adnan Menderes University Hospital, 09100, Aydın, Turkey

    Erkin Kır

  6. Department of Pathology, Adnan Menderes University Hospital, 09100, Aydın, Turkey

    İbrahim Meteoğlu

  7. Cumhuriyet Mahallesi, Adnan Menderes Bulvarı, No:6 Daire:7, 09020, Aydın, Turkey

    Mehmet Turgut

Authors
  1. Mehmet Turgut
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Yelda Özsunar
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sema Başak
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Engin Güney
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Erkin Kır
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. İbrahim Meteoğlu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mehmet Turgut.

Additional information

This is an overview of a very large series of pituitary apoplexy patients with a single illustrative case from a single institution. The authors make valid comments about surgical intervention and are saying, in essence, that it is always worth decompressing the visual apparatus if visual loss is severe.

As always, the discussion on timing of intervention is hampered by the retrospective nature of the series, but this adds valuable information to the surgical argument.

Ultimately, the answer will not be properly made until a carefully constructed RCT has been made, but for pituitary surgeons, aploplexy with visual loss is like central lumbar disk prolapse with cauda equina loss—if it was ourselves, we would want the operation done by an expert transsphenoidal surgeon once we had been biochemically and endocrinologically stabilized.

Michael Powell

London, UK

Rights and permissions

Reprints and permissions

About this article

Cite this article

Turgut, M., Özsunar, Y., Başak, S. et al. Pituitary apoplexy: an overview of 186 cases published during the last century. Acta Neurochir 152, 749–761 (2010). https://doi.org/10.1007/s00701-009-0595-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-009-0595-8

Keywords

Search

Navigation