title: Pituitary apoplexy in nonfunctioning pituitary macroadenomas: a case-control study.
abstract: OBJECTIVE
  Pituitary apoplexy (PA) is an endocrinologic emergency characterized by headache, visual abnormalities, and hemodynamic instability in the context of hemorragic infarction of a pituitary adenoma. Our goal was to estimate the incidence, precipitating factors, clinical characteristics, and outcome of PA in a cohort of patients with nonfunctioning pituitary macroadenomas (NFPMAs).
  
  
  METHODS
  A retrospective, case-control study of 46 patients with PA and 47 controls matched for age, gender, and tumor invasiveness. Clinical, hormonal, and tumoral charactersitics, as well as the presence of potential precipitating factors and long-term outcome were evaluated using both bivariate and multivariate analysis.
  
  
  RESULTS
  The prevalence of PA was 8%. Cases and controls were similar in regards to the prevalence of diabetes, hypertension, use of antiplatelet agents, and the presence of headaches and visual field defects. Oculomotor paralysis was present in 18% of cases and in none of the controls (P = .001). Prior use of dopamine agonists was significantly more frequent among cases than in controls on both bivariate and multivariate analysis. Pituitary hormone deficiencies were more common among cases than in controls on bivariate but not on multivariate analysis. Early and late surgical treatment was carried out in 11 and 25 patients, respectively; 11 patients were managed conservatively. Visual and endocrine outcomes were similar among the 3 groups.
  
  
  CONCLUSIONS
  PA represents a life-threatening medical emergency. Prior use of dopamine agonists and the presence of oculomotor abnormalities clearly distinguished patients with NFPMA who developed PA from those who did not.
authors.affiliation: Endocrinology Service/Experimental Endocrinology Unit.
authors.forename: Guadalupe
authors.initials: G
authors.lastname: Vargas
authors.affiliation: Endocrinology Service/Experimental Endocrinology Unit Neurological Center, American British Cowdray Medical Center, Mexico City, Mexico.
authors.forename: Baldomero
authors.initials: B
authors.lastname: Gonzalez
authors.affiliation: Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, Neurosurgery Service Neurological Center, American British Cowdray Medical Center, Mexico City, Mexico.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Guinto
authors.affiliation: Endocrinology Service/Experimental Endocrinology Unit.
authors.forename: Victoria
authors.initials: V
authors.lastname: Mendoza
authors.affiliation: Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, Neurosurgery Service.
authors.forename: Blas
authors.initials: B
authors.lastname: López-Félix
authors.affiliation: Hospital de Especialidades, Centro Médico Nacional Siglo XXI, IMSS, Neurosurgery Service.
authors.forename: Erick
authors.initials: E
authors.lastname: Zepeda
authors.affiliation: Endocrinology Service/Experimental Endocrinology Unit Neurological Center, American British Cowdray Medical Center, Mexico City, Mexico.
authors.forename: Moisés
authors.initials: M
authors.lastname: Mercado
mesh_terms: D000236:Adenoma; D016022:Case-Control Studies; D006801:Humans; D010899:Pituitary Apoplexy; D010911:Pituitary Neoplasms; D012189:Retrospective Studies