Natural history of pituitary apoplexy: a long-term follow-up study

Abstract

Background and aimsPituitary apoplexy (PA) is a rare neurosurgical emergency, associated with deficiency of one or more pituitary hormones. Few studies have explored the relative outcomes associated with conservative and neurosurgical intervention.MethodsA retrospective evaluation of all patients with PA reviewed at Morriston Hospital was undertaken and diagnosis was obtained from Morriston database (Leicester Clinical Workstation database) between 1998 and 2019 from clinic letters and discharge summaries.ResultsThirty-nine patients with PA were identified with a mean age of 74.5 years and 20 (51.3%) patients were women. Patients were followed up for a mean±SD 68.1±61.7 months. Twenty-three (59.0%) patients had a known pituitary adenoma. Commoner clinical presentations of PA were ophthalmoplegia or visual field loss. Following PA, 34 (87.2%) patients were noted to have a non-functioning pituitary adenoma (either pre-existing or new), while 5 (12.8%) patients had a pre-existing functional macroadenoma. Neurosurgical intervention was taken in 15 (38.5%) patients of which 3 (20.0%) patients also received radiotherapy, 2 (13.3%) patients had radiotherapy alone and the remainder managed conservatively. External ophthalmoplegia recovered in all cases. Visual loss remained in all cases. One (2.6%) patient with chromophobe adenoma had a significant second episode of PA requiring repeat surgery.ConclusionPA often occurs in patients with undiagnosed adenoma. Hypopituitarism commonly occurred following conservative or surgical treatment. External ophthalmoplegia resolved in all cases, however, visual loss did not recover. Pituitary tumour recurrence and further PA episodes are rare.

Pituitary apoplexy after surgery for cervical stump adenocarcinoma: A case report and literature review

“…It is usually caused by a sudden ischemic or hemorrhagic infarction of a preexisting pituitary adenoma, while only pituitary apoplexy rarely occurs in normal pituitary glands. Bonicki et al ( 3 ) reported that PA occurs in 5% of patients with pituitary adenomas; however, >40% of PA cases have never been diagnosed with a pituitary tumor prior to onset ( 21 ). PA is related to a variety of inducible factors, but its exact pathogenesis remains elusive.…”