Endocrine Abstracts

Introduction: Pituitary apoplexy is a potentially life-threatening syndrome due to acute infarction and/or hemorrhage of the pituitary gland. In many cases it is the first form of presentation of a pituitary adenoma. The purpose of the study is to analyze the clinical presentation, diagnosis and treatment of this syndrome.

Patients and methods: A retrospective analysis of the patients diagnosed with pituitary tumor apoplexy at Santo Antonio’s Hospital from 2000 to 2011 was done. Their medical records were reviewed.

Results: In total, 14 cases of pituitary tumor apoplexy were reviewed: 10 males and four females (mean age 47.8 years, range 21–71). They were followed for up to 10 years (mean 3.9 years, range 1–10). Only one case occurred on a previously known pituitary macroadenoma; all other occurred as first manifestation of the tumor. At the presentation, headache occurred on 11 cases (78.6%), visual changes on 10 (71.4%) and nausea/vomits on eight (57.1%); one patient was asymptomatic. MRI was done on 11 cases (78.6%); pituitary tumor hemorrhage and/or necrosis was correctly identified on all. Surgical treatment with transfenoidal surgery was done on 12 cases (85.7%), on average 4.5 days after hospital admission (range 1–13 days). Visual changes improved on all surgically treated. By immunostaining criteria, of the 12 surgically removed tumors, five (41.7%) were null-cell adenomas, three (25%) were GH-positive, two (16.7%) were FSH-positive and two were GH and PRL-positive.

Overall, nine patients needed long-term hormone replacement: steroid and thyroid hormones were required in eight cases (88.9%), testosterone therapy in five (55.6%). One patient needed long-term desmopressin therapy.

Conclusions: Pituitary apoplexy diagnosis relies on the presenting symptoms and it is usually confirmed by an imaging method, preferably MRI. Transfenoidal surgery is the most used technique and a sooner intervention carries a better prognosis. A significant percentage of patients need long-term hormone replacement.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.