Clinical and biochemical characteristics of patients presenting with pituitary apoplexy

Abstract

PurposeTo review the clinical and biochemical characteristics and clinical outcome of patients presenting with pituitary apoplexy to a tertiary centre.MethodsWe retrospectively reviewed the clinical features, predisposing factors, biochemistry and clinical outcome of patients presenting with pituitary apoplexy to Imperial College Healthcare NHS Trust between 1991 and 2015.ResultsWe identified 64 patients with pituitary apoplexy (more complete clinical records were available in 52 patients). The median age at presentation was 46.7 years (IQR 31.5–57.0 years). Pituitary apoplexy was the first presentation of pituitary disease in 38/52 of patients and predisposing factors were identified in 28/52. Pituitary apoplexy predominantly occurred in patients with non-functioning pituitary adenomas (47/52). Headache was most commonly described as sudden onset, severe, lateralising to the frontal or temporal regions. Symptoms of meningeal irritation were reported in 7/18 and visual abnormalities in 22/35. A pre-treatment serum cortisol <100 nmol/L was recorded in 12/31 of patients. All patients with visual disturbance had some resolution of their visual symptoms whether managed surgically (14/14) or conservatively (5/5), although pituitary endocrine function did not fully recover in any patient.ConclusionsIn conclusion, these data describe the clinical features of pituitary apoplexy to aid the clinician in diagnosing this rare emergency presentation of pituitary disease. Prospective multicentre studies of the presentation of pituitary apoplexy are required to further characterise presentation and outcomes.

Pituitary haemorrhage and infarction: the spectrum of disease

“…There were a higher number of men with the acute presentation and a higher number of women with subacute presentation although there was no statistical difference between groups. Although previous publications show variations in gender mix, there is a suggestion that this presentation is more common in men ( 2 ). All of the patients included in this series had presented with a pituitary macroadenoma.…”

“…Hypertension was more common in both cohorts and was above the prevalence expected for a population of this age. Again previous studies have come to differing conclusions about the link between blood pressure and pituitary haemorrhage/ infarction ( 2 , 19 ).…”

“…Severe headache is common. Pituitary apoplexy represents a rare condition in a common presentation ( 1 , 2 , 3 , 4 , 5 , 6 ). Diagnosis may be delayed and only made when appropriate imaging of the pituitary is performed.…”

Acute Sterile Meningitis as a Primary Manifestation of Pituitary Apoplexy

“…Visual abnormalities were common (62%) and included pupil abnormalities (20%), oculomotor nerve palsy (34%), abducens nerve palsies (22%), visual acuity changes (40%), and visual field cuts (35%). 3,4,8 Most patients presenting with headache and findings suspicious of subarachnoid bleed or PA undergo a noncontrast CT scan on an emergent basis. The sensitivity of noncontrast CT ranges between 21% and 46%.…”

Thunderclap headache as a presenting manifestation of pituitary apoplexy

“…L'apoplexie hypophysaire, bien que parfois associée à ce type de douleur est surtout marquée par l'existence de douleurs moins aiguës. Dans une étude rétrospective récente, Abbara et al 11 mettaient en évidence que les céphalées étaient le plus souvent fronto-temporales et unilatérales dans 64 % des cas et dans près de 80 % des cas elles étaient présentes depuis plus de 24 heures. De même, dans un quart des cas, les céphalées étaient présentes depuis plusieurs jours à plusieurs semaines.…”