Endocrine Abstracts (2007) 13 P199

Pituitary apoplexy: an experience from a tertiary care institution in south india

Thomas Paul, Nihal Thomas, Mandalam Seshdri, George Koshy, Ari Chacko & Geetha Chacko

Christian Medical College, Vellore,Tamil Nadu, India.

Background: Pituitary apoplexy is a neurological emergency, whose prevalence is generally underestimated. The overall prevalence ranges from 0.6 to 27.7% of all pituitary tumours.

Methodology: Retrospective analysis of hospital medical records of 274 patients with pituitary adenoma who presented to us between 1996–2006 was done.

Results: Of the 274 patients analysed, 84 had features of pituitary apoplexy (31%) Mean age was 44.7 years. The commonest clinical presentation was headache (88.1%). Of the patients with apoplexy, 47% had evidence of haemorrhage on CT Scan and 52.1% on MRI Scan. Intraoperative findings were available for 62 patients. Of these, 26 (41.9%) had fluid consistency of the tumour, 22 (30.5%) had blood and in 31(43.05%) xanthochromic fluid was seen during surgery. Histopathology showed evidence of haemorrhage, necrosis or a combination of these in 18 patients. Hypocortisolemia (8 am S Cortisol<5 microgram/dl) was seen in a greater proportion in the apoplexy group as compared to the non-apoplexy group (41.3% Vs 16%, P< 0.001) and central hypothyroidism (S. T4< 5 microgram /dl) was also seen significantly higher in patients with apoplexy(37% Vs 13.8%, P<0.001).

Conclusions: In our series apoplexy was seen in 31% of patients and they had significantly higher prevalence of hypocortisolemia and central hypothyroidism compared to the non apoplexy group.

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