Clinical aspects of spontaneous necrosis of pituitary tumors (pituitary apoplexy)

Abstract

Among 586 surgically treated tumors of the pituitary gland 72 cases (12.3%) of spontaneous necrosis of the tumor were found. However only in 10 cases (1.7%) were there clues of an additional rupture of the tumor with signs of meningeal reaction in the CSF. Cases with a relatively benign clinical course and signs of regression are more frequent than generally assumed. Spontaneous necrosis with and without rupture is much more frequent in endocrinologically inactive tumors (including prolactinomas) as opposed to STH- and ACTH-cell adenomas. Analyzing the patient material the clinical symptomatology and the differential diagnosis of spontaneous necrosis of the tumor with and without rupture are discussed.

Pituitary Apoplexy Manifesting as Massive Intracerebral Hemorrhage

“…Extravasation of blood from a bleeding pituitary tumor may enter the subarachnoid space resulting in the clinical presentation of SAH. [15][16][17]27) However, the present case manifested as massive ICH without SAH. Only one previous case report has involved ICH as the result of pituitary apoplexy.…”

“…[16][17][18] Various precipitating events have been implicated in the pathogenesis of pituitary apoplexy such as head trauma, arterial hypertension, diabetes mellitus, pregnancy, estrogen or bromocriptine therapy, cardiac surgery, increased intracranial pressure, radiotherapy, dynamic pituitary function tests, or anticoagulation. However, the condition occurs spontaneously in the majority of patients with pituitary adenoma.…”

“…2,3,8,9,13,16,24) Pituitary apoplexy is characterized by sudden onset of headache, visual impairment, or ophthalmoplegia caused by acute enlargement of the tumor. 3,6,11,26,27,30) Intratumoral hemorrhage is the most common type of hemorrhage, but subarachnoid hemorrhage (SAH), 16,17,19,27) and intra-ventricular hemorrhage 5,21,25) may also result from pituitary apoplexy. Only one case of intracerebral hemorrhage (ICH) has been associated with pituitary apoplexy.…”

Pituitary apoplexy initially mistaken for bacterial meningitis

“…Patients may have a swinging fever, meningeal reaction or CSF pleocytosis 2 4 5. This is a rare but recognised presentation, reported in 7/255 and 10/586 of two series 2 4…”

Manifestation of Subclinical Diabetes Insipidus due to Pituitary Tumor during Pregnancy.

“…The incidence of pituitary apoplexy in patients with pituitary tumors is reported to vary from 6 to 16.6% [17][18][19].…”