Pituitary tumor apoplexy: characteristics, treatment, and outcomes

Abstract

<jats:p>Pituitary tumor apoplexy is an uncommon event heralded by abrupt onset of severe headache, restriction of visual fields, deterioration of visual acuity, and weakness of ocular motility frequently coupled with clinical indications of decreased endocrine function. Hemorrhage into or necrosis of a preexisting sellar mass, usually a pituitary macroadenoma, produces an expansion of sellar contents. Compression of adjacent structures elicits the variable expression of symptoms referable to displacement of the optic nerves and chiasm and impingement of the third, fourth, and sixth cranial nerves. Damage to or destruction of the anterior pituitary leads to multiple acute and/or chronic hormone deficiencies in many patients. Medical management may be used in rare cases in which the signs and symptoms are mild and restricted to meningismus or ophthalmoplegia deemed to be stable. In patients with visual or oculomotor lability or an altered level of consciousness, expeditious surgical decompression, accomplished most commonly through a transsphenoidal approach, should be performed to save life and vision and to optimize the chance of regaining or maintaining pituitary function.</jats:p>

Spontaneous remission of acromegaly: apoplexy mimicking meningitis or meningitis as a cause of apoplexy?

“…More than half of all patients require hormone replacement following an episode of pituitary tumor apoplexy; therefore, endocrine monitoring is essential. Diabetes insipidus is uncommon (present in 2% to 3% of cases), perhaps due to different types of vascularization in the pituitary gland and the hypothalamus (2). Even though an MRI may indicate apparent complete disappearance of the adenoma, it is not likely that all the tumor cells have been fully destroyed, and there may be a risk of recurrence.…”

“…It was first described by Bailey in 1898 (1), and it is an infrequent complication of these tumors. Although pituitary adenomas comprise approximately 10% of intracranial tumors, the incidence of apoplexy among them is low, ranging from 2% to 7% when clinical signs and surgical or histopathological evidence are considered (2).…”

“…Dopamine agonists, radiotherapy, recent surgery, trauma, or pituitary function tests are the most commonly described ones (2).…”

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

“…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].…”

“…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].…”