Endocrine Abstracts (2002) 3 P191

Precipitating factors and surgical outcome in pituitary apoplexy

MJ Levy1, JR Pollock1, SE Baldeweg2, GS Conway2 & M Powell1

1Department of Surgical Neurology, National Hospital for Neurology and Neurosurgery, London, UK; 2Department of Endocrinology, The Middlesex Hospital, London, UK

Pituitary apoplexy is a rare condition caused by haemorrhage or infarction into a pituitary tumour. The majority of patients do not have any identifiable triggering event, although situations altering the blood flow to the pituitary gland and pre-existing systemic hypertension have been identified as potential causal factors.

We retrospectively reviewed the presentation and outcome of 15 patients with pituitary apoplexy (8 men, 7 women; age 16-87, mean 53 years). Clinical presentations included headache (100%), visual loss (67%) and ophthalmoplegia (73%). No prior pituitary disease was evident in 14 patients. In one patient a prolactinoma was previously diagnosed. Precipitating factors were found in 4/15 (27%): gastroenteritis, diabetic ketoacidosis, pneumonia and anticoagulation. Hypertension ( >160/90 mmHg) was seen in 33% of patients at presentation. The time between presentation and surgery ranged between 5 and 168 hours (mean 46.7 hours). 100% of those with visual loss had a documented improvement in visual fields and 60% of patients had complete resolution of visual deficits. The length of time between clinical presentation and surgery did not appear to be related to visual recovery. There were no deaths. Post-operative hypopituitarism was evident in 67% of patients who were then appropriately replaced. All specimens showed pathological evidence of necrosis or haemorrhage. 2 specimens had positive immunohistochemistry (growth hormone and prolactin).

The majority of cases of pituitary apoplexy have no obvious precipitating event and are associated with a favourable clinical outcome.

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