Introduction: Pituitary Apoplexy is a rare endocrine emergency which can occur due to infarction or haemorrhage of pituitary gland. Pituitary apoplexy can occur as an initial presentation in patients who are not known to have Pituitary adenomas. Clinical Symptoms vary, however, one should have a high index of suspicion if symptoms such as acute headache, visual loss or ocular palsy occur.
Precipitating factors: Hypertension, Preganancy, Head trauma, Dynamic testing of pituitary gland.
Methods and aims: The clinical data of all patients attending the Morriston Hospital pituitary clinic are recorded on leicester, a computerised database. A search revealed 43 patient from 1998 to date. Data was obtained from the database and clinic letters. Our aims: Pituitary adenoma causes, Previous history of Pituitary adenoma or first presentation, Management, Long term follow up and complications.
Results: Among 43 patients, 47% were male with the mean age of 60.4 years at presentation. Of these patients 3 had acromegaly, 1 had Cushings Disease, 2 had Macroprolactinoma, 3 had malignant secondaries and 1 had craniopharyngioma. The remaining 29 patients had non functioning adenomas. Among these patients 24 (37%) were not previously known to have a pituitary tumour. 15 (37%) presented with external ophthalmoplegia and 10 (23%) with visual loss. 5 (11%) presented with sudden blinding headaches and 12% with Nerve palsy. 17 patients had surgery of which 8 patients had radiotherapy. 2 only had radiotherapy purely due to the size of the tumour. The remainder were managed conservatively. Majority of patients developed hypopituitarism. Only 1 patient with chromophobe adenoma had a significant second episode of apoplexy requiring repeat surgery.
Learning points: Pituitary apoplexy is a rare endocrine emergency. Commonly occurring as first presentation in patients with unknown pituitary adenoma. External ophthalmoplegia recovered in all cases. Hypopituitarism is a common complication. Recurrence of pituitary apoplexy is rare.