Pituitary apoplexy is a rare syndrome due to hemorrhagic infarction of a pituitary adenoma. We analyze the circumstances of diagnosis, clinical features and evolution in a retrospective review of patients with pituitary apoplexy admitted between 2000 and 2010, diagnosed by pathological exam and/or suggestive imaging for pituitary haemorrhage.
Results: From 31 patients with pituitary apoplexy (11 women, 20 men) with a mean age of 48 years at diagnosis (2075 years), 24 patients had clinically non-functioning pituitary adenomas, 3 acromegaly, 3 prolactinomas and 1 Cushings disease all macroadenomas. In 90% of patients (28/31) the pituitary adenoma has not been previously diagnosed. In all patients apoplexy was clinically overt, with headaches in 96.5%, visual disturbances in 75.8%, vomiting in 51.8%, diabetes insipidus (DI) in 6.4% of patients. Previous or current pregnancy was noted in 2 patients, dopamine agonist treatment in 3, trauma in 2, trombolysis for coronary event in 1 patient. Pituitary surgery was done in 27 patients (7 by frontal, 20 by transsphenoidal approach). In 7 patients with hypopituitarism identified at diagnosis, the pituitary function recovered in 2 of the 4 operated patients. Cure of a hypersecreting tumor was recorded in 1 operated and in 2 non-operated patients. After surgery, hypopituitarism was diagnosed in 21/26 patients (80.8%), transient DI in 6/26 (23%). However surgery induced complete recovery of the visual disturbances in 9/22 (41%) and partial recovery in 8/22 (36%) of the affected patients. After a median follow-up of 31.5 months (6300 months), hypopituitarism improved in 5/24 patients (20%), none of the tumors showed re-growth, in 6/18 patients (33%) the tumors decreased spontaneously by more than 50% and 5/20 patients (25%) were tumor-free.
Conclusion: Pituitary apoplexy may result in spontaneous tumor remission (6% in our series), but is frequently associated with hypopituitarism.
30 Apr - 04 May 2011
European Society of Endocrinology