Pituitary apoplexy and its effect on vision

Abstract

A series of 15 patients with a clinical diagnosis of pituitary apoplexy is reviewed. Clinical features are highlighted, with stress on the defects of visual function and ocular motility, and the associated endocrine abnormalities are described. Potential diagnostic errors and their significance are considered. The incidence of this complication in a large series of pituitary adenoma patients is measured, and the radiological and pathological findings are recorded. The results of treatment by surgery and/or radiotherapy and/or bromocriptine are assessed, particularly in relation to visual consequences, and compared with previous reports in the literature, which are reviewed.

Corticotroph Cell Adenoma without Typical Manifestations of Cushing's Disease Presenting with Cavernous Sinus Syndrome following Pituitary Apoplexy.

“…Ophthalmoplegia is well known to be caused by a sudden increase in tumor mass associated with pituitary hemorrhage [13] and is reported to be a consequence of tumor invasion of the cavernous sinus [14]. In the present case, these signs were presumed to be caused by rapid compression of the venous channel to the cavernous sinus secondary to pituitary apoplexy because ophthalmoplegia was not present, tumor invasion into the cavernous sinus was not observed in surgery, and these signs immediately resolved after surgery.…”

Pituitary tumor apoplexy

“…The hypothesis of tumoral "intrinsic" factors ending to hemorrhage is also suggested. There is a statistically significant relationship between the aggressive and invasive tumoral behavior and hemorrhage 11,23 . The role of vasospasm was also implicated on the etiophatology of pituitary infarction.…”

“…Notwithstanding pituitary apoplexy occurs within pituitary adenomas, it may also occur in non-adenomatous or even the normal pituitary gland 6 , especially during pregnancy. Although the "subclinical pituitary apoplexy" [7][8][9] terminology is widely used to describe anatomophatological evidence of asymptomatic pituitary ischemia or hemorrhage, it is meaningful to note that pituitary apoplexy is a clinical syndrome rather than an anatomopathological definition 10,11 .…”

A case of pituitary apoplexy following posterior lumbar fusion surgery

“…However, lethargy is a very common problem that can block us from making accurate visual examinations. 7 Computed tomography is an emergency-setting tool for immediately evaluating the brain. Hemorrhage can be detected on CT 3 days after the onset of PA. 10,13 Magnetic resonance imaging is the best evaluation tool after the diagnosis of PA on CT. Tumor, hemorrhage, and infarction can be better differentiated on MRI.…”

“…Some authors have stated that the time for surgery does not affect the outcome of visual disturbances and have advocated early surgical decompression within 6-8 days of apoplexy. 7,10,13 After surgery, ophthalmoplegia recovers better than visual field defects.…”