title: A conservative management is preferable in milder forms of pituitary tumor apoplexy.
abstract: OBJECTIVE
  Our objective was to report a single-center experience of the management of pituitary tumor apoplexy.
  
  
  METHODS
  We retrospectively analyzed a series of 44 patients hospitalized for pituitary apoplexy between January 1996 and March 2008 at the Timone Hospital, Marseille, France.
  
  
  RESULTS
  Most frequent presenting symptoms were headaches (93%), visual impairment (85%) and vomiting (59%). Hypopituitarism was present at diagnosis in 88% of patients, with a high incidence of corticotroph deficiency (70%). A risk factor was found in 52% of patients, mostly hypertension. Apoplexy occurred in a previously undiagnosed pituitary adenoma in 32/44 cases (73%). The apoplectic event concerned 12 secreting, 27 non-functioning, 4 uncharacterized adenomas and one Rathke's pouch cyst. Nineteen patients underwent surgery within the first month, and one patient had conventional radiotherapy. Twenty-four patients, who had no ophthalmic or neurological signs, were conservatively treated in first intention; among them, 6 received high dose corticosteroids. After a median follow-up of 21 months, there was no significant difference in terms of endocrine or visual recovery between the operated and the conservatively treated groups, nor between patients treated with corticosteroids or not. Panhypopituitarism was observed in 52% of patients, but partial or complete visual recovery was present in the majority of patients (91%), whatever the therapeutic approach.
  
  
  CONCLUSIONS
  The outcome of patients treated with or without surgery for pituitary apoplexy without severe neuro-ophthalmic deficits seems to be identical, pleading for a conservative management of pituitary apoplexy in the absence of visual emergency.
authors.affiliation: Department of Endocrinology, Timone Hospital, 204, Rue Saint-Pierre, 13385 Marseille Cedex 05, France.
authors.forename: C
authors.initials: C
authors.lastname: Leyer
authors.forename: F
authors.initials: F
authors.lastname: Castinetti
authors.forename: I
authors.initials: I
authors.lastname: Morange
authors.forename: M
authors.initials: M
authors.lastname: Gueydan
authors.forename: C
authors.initials: C
authors.lastname: Oliver
authors.forename: B
authors.initials: B
authors.lastname: Conte-Devolx
authors.forename: H
authors.initials: H
authors.lastname: Dufour
authors.forename: T
authors.initials: T
authors.lastname: Brue
mesh_terms: D000236:Adenoma / Q000150:complications / Q000473:pathology / Q000628:therapy; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D010899:Pituitary Apoplexy / Q000209:etiology* / Q000628:therapy*; D010911:Pituitary Neoplasms / Q000150:complications* / Q000473:pathology / Q000628:therapy*; D012189:Retrospective Studies; D015354:Vision, Low / Q000209:etiology / Q000628:therapy; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones
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