title: Classical pituitary apoplexy presentation and a follow-up of 13 patients.
abstract: Thirteen patients who presented with signs and symptoms of pituitary disease gave a history of classical pituitary apoplexy. Six presented with acute symptoms and in 7 the history antedated the admission by a mean of 887 days (range 365-2,190 days). All patients had an enlarged eroded sella. CT scans revealed a bleed in the tumor in 11 (histologically confirmed in all 8 patients operated), evidence of residual tumor in 1 and an empty sella (ES) in 1 patient. Hypopituitarism was present in 9, 4 were endocrinologically normal, 8 had visual problems requiring decompressive surgery and radiotherapy (RT) was given to 7 patients. They were subsequently followed for a median period of 730 days (range 365-3,385 days). During this time an empty sella developed in 5, 2 of whom had no surgery or RT; 4 remained endocrinologically normal, and a second hemorrhage occurred in 2 patients. Histological evidence of previous bleeds was noted in 6 of the 8 patients treated surgically. We conclude that apoplexy (1) may produce complete or partial tumor destruction with or without preservation of endocrine function; (2) recurrent, often silent, bleeding into a pituitary tumor appears to be a common event; (3) RT should be withheld unless recurrent tumor is documented (since at least 2 patients in this study have experienced spontaneous resolution of the tumor); and (4) the presence of an enlarged eroded fossa with an ES is reasonable presumptive evidence of an infarction of a pre-existing pituitary tumor.
authors.affiliation: Department of Medicine, King Faisal Specialist Hospital, Riyadh, Saudi Arabia.
authors.forename: M
authors.initials: M
authors.lastname: Ahmed
authors.forename: A
authors.initials: A
authors.lastname: Rifai
authors.forename: M
authors.initials: M
authors.lastname: Al-Jurf
authors.forename: M
authors.initials: M
authors.lastname: Akhtar
authors.forename: N
authors.initials: N
authors.lastname: Woodhouse
mesh_terms: D000328:Adult; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010899:Pituitary Apoplexy / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D010911:Pituitary Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed