Analytic Review: Pituitary Tumor Apoplexy: A Review

Abstract

Pituitary tumor apoplexy is an uncommon syndrome resulting often spontaneously from hemorrhage or infarction of a pre-existing pituitary adenoma. As the primary event involves the adenoma, the syndrome should be referred to as pituitary tumor apoplexy and not as pituitary apoplexy. The sudden increase in sellar contents compresses surrounding structures and portal vessels, resulting in sudden, severe headache, visual disturbances, and impairment in pituitary function. Initial management of patients with pituitary tumor apoplexy includes supportive therapy (intravenous fluids and corticosteroids), following which many patients exhibit clinical improvement. Because those patients can be effectively managed with supportive measures, many who remain clinically and neurologically unstable might benefit from urgent surgical decompression by an experienced neurosurgeon. All patients presenting with this syndrome require long-term follow-up to treat any residual tumor and/or pituitary dysfunction. Close interaction between members of the management team is necessary for optimal patients' outcome.

Endoscopic Endonasal Transsphenoidal Treatment of Pituitary Apoplexy: Outcomes in a Series of 20 Patients

“…This condition can be difficult to diagnose unequivocally due to variations in symptomatology and the degree of severity at presentation as well as possible mimicry of other disease processes. Radiological imaging studies, intraoperative findings, and pathological examinations, together with patients' symptomatology, are usually combined to confirm the diagnosis retrospectively [1]. The general consensus is that pituitary apoplexy is a clinical diagnosis most likely resulting from the hemorrhage/infarction of an underlying pituitary tumor and subsequent sudden and fulminant volume expansion [1][2].…”

“…Typical presenting signs and symptoms often include sudden severe headaches, visual loss or decreased visual acuity, visual field cut, ophthalmoplegia, altered mental status, and impaired pituitary function [1][2]. It is generally considered a diagnosis based on symptoms and imaging; however, intraoperative and pathological findings of hemorrhage have been used to identify "subclinical (asymptomatic) apoplexy" [1,3].…”

“…It is generally considered a diagnosis based on symptoms and imaging; however, intraoperative and pathological findings of hemorrhage have been used to identify "subclinical (asymptomatic) apoplexy" [1,3]. The severity of the symptoms can vary and the diagnosis is not always straightforward [1,[3][4]. The manifestations of pituitary apoplexy are attributed to the rapid expansion of an infarcted and/or hemorrhagic pituitary adenoma that has extended laterally into the cavernous sinus or superiorly to displace the optic chiasm and apparatus, with an occasional extension of the hemorrhage into the surrounding subarachnoid space [1][2].…”

“…The severity of the symptoms can vary and the diagnosis is not always straightforward [1,[3][4]. The manifestations of pituitary apoplexy are attributed to the rapid expansion of an infarcted and/or hemorrhagic pituitary adenoma that has extended laterally into the cavernous sinus or superiorly to displace the optic chiasm and apparatus, with an occasional extension of the hemorrhage into the surrounding subarachnoid space [1][2]. MRI imaging is the most sensitive radiological modality for the detection/discrimination of acute and chronic intracranial hemorrhages and has been recommended for all suspected cases to provide information to guide management [5][6][7].…”

Pituitary apoplexy: pathophysiology, diagnosis and management

“…PA occurs in 0.6% to 10% of treated pituitary adenomas (5) and its risk in non-functioning pituitary adenomas is 0.2-0.6 events per 100 person-year (6,7).…”