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Apoplexy in nonfunctioning pituitary adenomas

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Abstract

Pituitary apoplexy is an uncommon event, occurring due to the infarction and/or haemorrhage usually of a previously unknown pituitary adenoma. It can occur in all adenoma subtypes but is more common in nonfunctioning pituitary adenomas. The physiopathology is not completely clear, and precipitating factors, such as major surgeries, anticoagulant use or pituitary dynamic tests, can be found in up to 40% of patients. The clinical presentation is characterized by a rapid onset with a headache as the main symptom, but visual disturbances can also be present as well as meningism and intracranial hypertension. The diagnosis is based on imaging evaluations, mainly using magnetic resonance imaging, which can show various patterns depending on the timeframe following the occurrence of the apoplectic event. Pituitary hormonal deficits are also common, and the evaluation of hormonal levels is mandatory. Pituitary apoplexy can be managed by surgery or conservative treatment, and a multidisciplinary team is essential for the decision-making process. The outcome is usually positive with both surgical and conservative approaches, but surveillance is needed due to the risk of re-bleeding or tumour recurrence.

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Authors and Affiliations

  1. Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rua Professor Rodolpho Paulo Rocco, 255, 9° andar - Setor 9F - Sala de Pesquisa em Neuroendocrinologia, Ilha do Fundão, Rio de Janeiro, 21941-913, Brazil

    Luiz Eduardo Wildemberg & Mônica R. Gadelha

  2. Neuroendocrinology Division, Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil

    Luiz Eduardo Wildemberg & Mônica R. Gadelha

  3. Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das Clinicas, University of Sao Paulo Medical School, São Paulo, SP, Brazil

    Andrea Glezer & Marcello D. Bronstein

Authors
  1. Luiz Eduardo Wildemberg
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  2. Andrea Glezer
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  3. Marcello D. Bronstein
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  4. Mônica R. Gadelha
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Correspondence to Mônica R. Gadelha.

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Wildemberg, L.E., Glezer, A., Bronstein, M.D. et al. Apoplexy in nonfunctioning pituitary adenomas. Pituitary 21, 138–144 (2018). https://doi.org/10.1007/s11102-018-0870-x

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  • DOI: https://doi.org/10.1007/s11102-018-0870-x

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