Pituitary

, Volume 7, Issue 3, pp 157–163 | Cite as

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

  • Latika Sibal
  • Steve G. Ball
  • Vincent Connolly
  • Robert A. James
  • Philip Kane
  • William F. Kelly
  • Pat Kendall-Taylor
  • David Mathias
  • Petros Perros
  • Richard Quinton
  • Bijay Vaidya
Article

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 apoplexy pituitary adenoma hypopituitarism visual loss 

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Copyright information

© Springer Science + Business Media, Inc. 2005

Authors and Affiliations

  • Latika Sibal
    • 1
  • Steve G. Ball
    • 1
  • Vincent Connolly
    • 2
  • Robert A. James
    • 1
  • Philip Kane
    • 3
  • William F. Kelly
    • 2
  • Pat Kendall-Taylor
    • 1
  • David Mathias
    • 4
  • Petros Perros
    • 1
  • Richard Quinton
    • 1
  • Bijay Vaidya
    • 2
    • 5
  1. 1.Department of EndocrinologyNewcastle University Teaching HospitalsNewcastle upon TyneUK
  2. 2.Department of EndocrinologyThe James Cook University HospitalMiddlesbroughUK
  3. 3.Department of NeurosurgeryThe James Cook University HospitalMiddlesbroughUK
  4. 4.Departments of OtonasolaryngologyNewcastle University Teaching HospitalsNewcastle upon TyneUK
  5. 5.Department of Endocrinology, Diabetes & Vascular MedicinePeninsula Medical School, Royal Devon & Exeter HospitalExeterUK

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