A conservative management is preferable in milder forms of pituitary tumor apoplexy.
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.
Leyer
C
C
Department of Endocrinology, Timone Hospital, 204, Rue Saint-Pierre, 13385 Marseille Cedex 05, France.
Castinetti
F
F
Morange
I
I
Gueydan
M
M
Oliver
C
C
Conte-Devolx
B
B
Dufour
H
H
Brue
T
T
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
D000305:Adrenal Cortex Hormones
Surg Neurol. 1982 Sep;18(3):181-9
7179072
Br J Neurosurg. 2006 Dec;20(6):379-85
17439089
Neurosurgery. 1984 Mar;14(3):363-73
6369168
Acta Neurochir (Wien). 2005 Feb;147(2):151-7; discussion 157
15570437
Pituitary. 2004;7(3):157-163
16010459
Am J Med. 1989 Jul;87(1):103-5
2662767
J Neurosurg Sci. 1999 Mar;43(1):25-36
10494663
Neurosurg Focus. 2004 Apr 15;16(4):E6
15191335
Endocrinol Metab Clin North Am. 1993 Jun;22(2):291-302
8325288
J Neurol Neurosurg Psychiatry. 2001 Oct;71(4):542-5
11561045
Clin Endocrinol (Oxf). 2006 Mar;64(3):319-22
16487443
Medicine (Baltimore). 2005 May;84(3):188-196
15879908
Neurosurgery. 2005;56(1):65-72; discussion 72-3
15617587
Acta Neurochir (Wien). 2007 Jun;149(6):557-65; discussion 565
17468811
Pituitary. 2004;7(3):189-192
16328568
Neurosurgery. 1993 Oct;33(4):602-8; discussion 608-9
8232799
J Neurosurg. 2006 Jun;104(6):931-7
16776337
J Med Case Rep. 2007 Aug 30;1:74
17761001
AJNR Am J Neuroradiol. 2002 Aug;23(7):1240-5
12169486
Neurochirurgie. 2006 Sep;52(4):330-8
17088713
J Clin Endocrinol Metab. 1995 Jul;80(7):2190-7
7608278
J Neurosurg. 2006 Jun;104(6):892-8
16776332
Clin Neurol Neurosurg. 2007 Jan;109(1):63-70
16488532
Clin Endocrinol (Oxf). 1999 Aug;51(2):181-8
10468988
Endocr J. 2005 Feb;52(1):117-23
15758567
Expert Opin Pharmacother. 2004 Jun;5(6):1287-98
15163274
Clin Endocrinol (Oxf). 2004 Dec;61(6):747-52
15579190
J Neurosurg. 1981 Aug;55(2):187-93
7252541
Clin Endocrinol (Oxf). 2003 May;58(5):545-9
12699434
Neth J Med. 2004 Nov;62(10):393-6
15683096
J Intensive Care Med. 2008 Mar-Apr;23(2):75-90
18372348