Clinical features and surgical outcome of clinical and subclinical pituitary apoplexy.
The clinical features of pituitary hemorrhage vary from asymptomatic to catastrophic. Clinical symptomatic pituitary apoplexy is a well-described syndrome characterized by sudden headaches, visual impairment, hypopituitarism and, at times, impaired consciousness. Subclinical pituitary apoplexy is characterized by minimal atypical clinical manifestations and, as a result, may be misdiagnosed or inappropriately treated. The purpose of the study was to evaluate the clinical manifestations, surgical outcome and post-operative pituitary function in patients who had clinical or subclinical pituitary apoplexy. We retrospectively identified 65 patients (30 men, 35 women; age range 21-87 years, mean age 48.4 years) who underwent transsphenoidal surgery. Of these, 25 patients were diagnosed as having clinical apoplexy, while the remaining 40 patients were classified as having subclinical pituitary apoplexy. The follow-up period ranged from 21 to 73 months (mean 44 months). Vision improved in 14 of 22 patients with clinical apoplexy (64%) and in 26 of 28 patients with subclinical apoplexy (93%) (p=0.017); the total resection rate was 57% and 42%, respectively (p=0.285). After 2 years of follow-up, hormone replacement therapy was needed in only 26% and 36% of patients, respectively (p=0.149). Our findings suggest that the incidence of subclinical pituitary apoplexy is higher than that of clinical pituitary apoplexy. Both the tumor resection rate and mean age were higher in those with clinical pituitary apoplexy, while those who had subclinical pituitary apoplexy demonstrated better visual improvement. During long-term follow-up, the need for hormonal replacement decreased in both groups.
Liu
Zhuo Hao
ZH
Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung Medical College and University, 5 Fu-Shin Street, Kwei-Shan Hsiang, Taoyuan Hsien 333, Taiwan.
Chang
Chen Nen
CN
Pai
Ping Ching
PC
Wei
Kuo Chen
KC
Jung
Shih Ming
SM
Chen
Nan Yu
NY
Chuang
Chi Cheng
CC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006728:Hormones / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D010899:Pituitary Apoplexy / Q000188:drug therapy / Q000209:etiology / Q000378:metabolism / Q000601:surgery*; D010911:Pituitary Neoplasms / Q000150:complications / Q000601:surgery*; D011183:Postoperative Complications; D020127:Recovery of Function; D012189:Retrospective Studies; D013101:Sphenoid Sinus / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D055815:Young Adult
D006728:Hormones