title: Pituitary apoplexy: a review of clinical presentation, management and outcome in 45 cases.
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.
authors: Department of Endocrinology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, UK.
authors: Latika
authors: L
authors: Sibal
authors: Department of Endocrinology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, UK.
authors: Steve G
authors: SG
authors: Ball
authors: Department of Endocrinology, The James Cook University Hospital, Middlesbrough, UK.
authors: Vincent
authors: V
authors: Connolly
authors: Department of Endocrinology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, UK.
authors: Robert A
authors: RA
authors: James
authors: Department of Neurosurgery, The James Cook University Hospital, Middlesbrough, UK.
authors: Philip
authors: P
authors: Kane
authors: Department of Endocrinology, The James Cook University Hospital, Middlesbrough, UK.
authors: William F
authors: WF
authors: Kelly
authors: Department of Endocrinology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, UK.
authors: Pat
authors: P
authors: Kendall-Taylor
authors: Departments of Otonasolaryngology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, UK.
authors: David
authors: D
authors: Mathias
authors: Department of Endocrinology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, UK.
authors: Petros
authors: P
authors: Perros
authors: Department of Endocrinology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, UK.
authors: Richard
authors: R
authors: Quinton
authors: 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.
authors: Bijay
authors: B
authors: Vaidya
mesh_terms: 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
chemical_list: D000305:Adrenal Cortex Hormones; D004873:Ergolines; D000077465:Cabergoline