Acta Neurochirurgica

, Volume 120, Issue 3–4, pp 118–122 | Cite as

Pituitary apoplexy: Endocrine, surgical and oncological emergency. Incidence, clinical course and treatment with reference to 799 cases of pituitary adenomas

  • W. Bonicki
  • A. Kasperlik-Załuska
  • W. Koszewski
  • W. Zgliczyński
  • J. Wisławski
Clinical Articles

Summary

Authors analised retrospectively the incidence of pituitary apoplexy in a series of 799 pituitary adenomas with respect to the long term follow-up of the patients.

Focal vascular abnormalities in histological specimens of tumours, regarded as morphological suggestion of past apoplexy (heamorrhage, ischaemic infarction or necrosis), were established in 113 out of 783 surgical cases (14.4%).

Acute clinical onset, justifying the clinical diagnosis of pituitary apoplexy, occurred in 39 patients only (5% of the whole series), 19 of them were subjected to urgent surgical decompression due to severe neurological deficit. The haemorrhagic character of apoplexy was established in most cases requiring immediate surgery.

The detailed clinical picture of this condition and its management are discussed with respect to the long term prognosis.

On this basis the authors suggest the necessity of surgical treatment in every case of pituitary apoplexy, taking into account not only neurological recovery, but also endocrine and oncological aspects of the disease. The observation that pituitary apoplexy may be a “marker” of tumour invasiveness (even in small, “enclosed” adenomas) is highlighted.

Keywords

Pituitary apoplexy pituitary haemorrhage ischaemic infarction pituitary adenoma 

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References

  1. 1.
    Arafah BM, Harrington JF, Madhoun ZT,et al (1990) Improvement of pituitary function after surgical decompression for pituitary tumour apoplexy. J Clin Endocrinol Metab 71: 323–328PubMedGoogle Scholar
  2. 2.
    Bernstein M, Hegete R, Gentili F (1984) Pituitary apoplexy associated with a triple bolus test. J Neurosurg 61: 586PubMedGoogle Scholar
  3. 3.
    Byerre P, Lindholm J, Viderae KH (1986) The spontaneous course of pituitary adenomas and occurence of an empty sella in untreated acromegaly. J Clin Endocrinol Metab 63: 287–291PubMedGoogle Scholar
  4. 4.
    Cardoso ER, Peterson EW (1984) Pituitary apoplexy. A review. Neurosurgery 14: 363–373PubMedGoogle Scholar
  5. 5.
    Chapman A, Williams G, Hockley A,et al (1985) Pituitary apoplexy after combined test of anterior pituitary function. Brit Med J 291: 26–29Google Scholar
  6. 6.
    Ebersold MJ, Laws ER, Scheithauer BW,et al (1983) Pituitary apoplexy treated by transsphenoidal surgery. J Neurosurg 58: 315–320PubMedGoogle Scholar
  7. 7.
    Gorczyca W, Hardy J (1988) Microadenomas of the human pituitary and their vascularisation. Neurosurgery 22: 1–6PubMedGoogle Scholar
  8. 8.
    Hodgkinson S, Allolio B, Landon J,et al (1984) Development of a non-extracted two-site immuno-radiometric assay for corticotropin utilizing amino —a and carboxy-terminally directed antibodies. Biochemistry J 218: 703–706Google Scholar
  9. 9.
    Jordan RM, Cook DM, Kendall JW,et al (1979) Nelson's syndrome and spontaneous pituitary tumour infarction. Arch Intern Med 139: 340–342CrossRefPubMedGoogle Scholar
  10. 10.
    Kasperlik-Zaiuska AA, Nielubowicz J, Wisławski J,et al (1983) Nelson's syndrome: incidence and prognosis. Clin Endocrinol 19: 693–698Google Scholar
  11. 11.
    Landolt AM (1980) Biology of pituitary microadenomas. In: Faglia G, Gionvanelli MA, MacLeod RM (eds) Pituitary microadenomas. Academic Press, London, pp 107–122Google Scholar
  12. 12.
    Laws ER Jr, Ebersold MJ (1983) Pituitary apoplexy—an endocrine emergency. World J Surg 6: 686–688CrossRefGoogle Scholar
  13. 13.
    Montalban J, Sumalla J, Fernandez JL (1988) Empty sella syndrome and pituitary apoplexy. Lancet 1: 774CrossRefGoogle Scholar
  14. 14.
    Pozzati E, Frank G, Nasi MT, Giulani G (1987) Pituitary apoplexy, bilateral carotid vasospasm and cerebral infarction in a 15-year-old boy. Neurosurgery 20 (1): 56–59PubMedGoogle Scholar
  15. 15.
    Rouit RL, Fein JM (1972) Pituitary apoplexy: a review and reappraisal. J Neurosurg 37: 280–288PubMedGoogle Scholar
  16. 16.
    Shirataki K, Chihara K, Shibata Y,et al (1988) Pituitary apoplexy manifested during a bromocriptine test in patient with a growth hormone —and prolactin —producing pituitary adenoma. Neurosurgery 23: 395–397PubMedGoogle Scholar
  17. 17.
    Symon L, Mohanty S (1982) Haemorrhage in pituitary tumours. Acta Neurochir (Wien) 65: 41–49CrossRefGoogle Scholar
  18. 18.
    Taylor AL, Finster JL, Raskin P,et al (1968) Pituitary apoplexy in acromegaly. J Clin Endocrinol Metab 28: 1784–1792PubMedGoogle Scholar
  19. 19.
    Wakai S, Fukushima T, Teramoto A,et al (1981) Pituitary apoplexy: its incidence and clinical significance. J Neurosurg 55: 187–193PubMedGoogle Scholar
  20. 20.
    Wisiawski J, Kasperlik-Załuska AA, Jeske W,et al (1985) Results of neurosurgical treatment by a transsphenoidal approach in 10 patients with Nelson's syndrome. J Neurosurg 62: 68–71PubMedGoogle Scholar

Copyright information

© Springer-Verlag 1993

Authors and Affiliations

  • W. Bonicki
    • 1
  • A. Kasperlik-Załuska
    • 2
  • W. Koszewski
    • 1
  • W. Zgliczyński
    • 2
  • J. Wisławski
    • 1
  1. 1.Department of NeurosurgeryMedical AcademyWarsaw
  2. 2.Department of EndocrinologyCenter of Postgraduate Medical EducationWarsawPoland

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