Pituitary apoplexy: a review of clinical presentation, management and outcome in 45 cases.
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.
Sibal
Latika
L
Department of Endocrinology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, UK.
Ball
Steve G
SG
Department of Endocrinology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, UK.
Connolly
Vincent
V
Department of Endocrinology, The James Cook University Hospital, Middlesbrough, UK.
James
Robert A
RA
Department of Endocrinology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, UK.
Kane
Philip
P
Department of Neurosurgery, The James Cook University Hospital, Middlesbrough, UK.
Kelly
William F
WF
Department of Endocrinology, The James Cook University Hospital, Middlesbrough, UK.
Kendall-Taylor
Pat
P
Department of Endocrinology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, UK.
Mathias
David
D
Departments of Otonasolaryngology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, UK.
Perros
Petros
P
Department of Endocrinology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, UK.
Quinton
Richard
R
Department of Endocrinology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, UK.
Vaidya
Bijay
B
Department of Endocrinology, The James Cook University Hospital, Middlesbrough, UK. bijay.vaidya@pms.ac.uk.|Department of Endocrinology, Diabetes & Vascular Medicine, Peninsula Medical School, Royal Devon & Exeter Hospital, Exeter, EX2 5DW, UK. bijay.vaidya@pms.ac.uk.
D000208:Acute Disease; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000077465:Cabergoline; D003131:Combined Modality Therapy; D019299:Decompression, Surgical; D004873:Ergolines / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007018:Hypopituitarism / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010899:Pituitary Apoplexy / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D010902:Pituitary Gland / Q000187:drug effects / Q000601:surgery; D010911:Pituitary Neoplasms / Q000150:complications / Q000175:diagnosis / Q000473:pathology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014786:Vision Disorders / Q000175:diagnosis / Q000209:etiology / Q000473:pathology
D000305:Adrenal Cortex Hormones; D004873:Ergolines; D000077465:Cabergoline