title: Neuro-ophthalmic manifestations and outcomes of pituitary apoplexy--a life and sight-threatening emergency.
abstract: OBJECTIVE
  To report the neuro-ophthalmic manifestations and outcomes in patients with pituitary apoplexy.
  
  
  METHODS
  Retrospective chart review.
  
  
  RESULTS
  23 patients were identified (17 men, mean age 54.1 years (range 23-86 years). The onset was abrupt in 22 patients; one patient had a subclinical presentation. Headache was the commonest presenting symptom (82.6%, 19/23). Neuro-ophthalmic manifestations were present in more than three-quarters of the patients (82.6%, 19/23). At presentation, 55 % (11/20), 47.6 % (10/21) and 60.9 % (14/23) of the patients had reduced visual acuity, field defects and cranial nerve palsies respectively. Management was conservative in 4 patients and surgical in 18 patients; one patient died shortly after presentation. The median follow up period was 10.5 months (22 patients, range 0.2-168 months).  At final follow up, improvement was present in 100% of the patients with reduced acuity (8/8) and ocular palsy (13/13) and 81.8% of patients with field deficits (9/11). Age, sex, presence of precipitating factors and timing of surgery did not have an impact on neuro-ophthalmic recovery.
  
  
  CONCLUSIONS
  Pituitary apoplexy should be considered in any patient with abrupt onset of neuro-ophthalmic deficits. Prompt medical and surgical management is lifesaving and can lead to significant improvement in visual and cranial nerve deficits.
authors.affiliation: South Australian Institute of Ophthalmology, Level 8, Royal Adelaide Hospital, North Terrace, Adelaide-5000, Australia. sumusimon@yahoo.co.in
authors.forename: Sumu
authors.initials: S
authors.lastname: Simon
authors.forename: David
authors.initials: D
authors.lastname: Torpy
authors.forename: Brian
authors.initials: B
authors.lastname: Brophy
authors.forename: Peter
authors.initials: P
authors.lastname: Blumbergs
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selva
authors.forename: John L
authors.initials: JL
authors.lastname: Crompton
mesh_terms: D000236:Adenoma / Q000175:diagnosis / Q000628:therapy; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000473:pathology; D002543:Cerebral Hemorrhage / Q000473:pathology; D002544:Cerebral Infarction / Q000473:pathology; D003389:Cranial Nerve Diseases / Q000209:etiology* / Q000628:therapy; D003951:Diagnostic Errors; D004172:Diplopia / Q000209:etiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006261:Headache / Q000209:etiology*; D006801:Humans; D007018:Hypopituitarism / Q000209:etiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D010899:Pituitary Apoplexy / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D010911:Pituitary Neoplasms / Q000175:diagnosis / Q000628:therapy; D015175:Prolactinoma / Q000175:diagnosis / Q000628:therapy; D012189:Retrospective Studies; D014786:Vision Disorders / Q000209:etiology* / Q000628:therapy; D014792:Visual Acuity; D014794:Visual Fields; D014839:Vomiting / Q000209:etiology; D055815:Young Adult