Pituitary Hemorrhage : Classification and Related Factors

Abstract

Objective : Clinical features of pituitary hemorrhage vary from asymptomatic to catastrophic. The purpose of this study was to evaluate the factors related to severity of hemorrhage of pituitary adenoma. Methods : Pituitary hemorrhage was noted in 32 of 88 patients who underwent operations between January 2000 and December 2007. Clinical status was classified into group I (no hemorrhage symptoms), II (mild to moderate symptoms without neurological deficit), and III (with neurological deficit), and was compared to radiological, pathological, and operative findings. All patients were operated by transsphenoidal approach, and hemorrhage-related symptoms were relieved. Results : Groups I, II, and III comprised 15, 10 and 7 patients, respectively. In group I, hemorrhage volume was under 1 mL in 11 (73.3%), but, it was above 1 mL in 7 (70%) of group II and in all cases of group III. Hemorrhage stage based on MRI findings was chronic or subacute in 11 (73.3%) of group I, acute in 6 (60%) of group II, and acute or hyperacute in 6 (85.7%) of group III. Pathological examination revealed chronic-stage hematomas in 5 (50%) group II patients. Functioning adenomas were found in 5 (33.3%) group I patients but none in group II or III patients. Silent adenomas were found in 4 (26.7%), 8 (80%), and 3 (42.9%) in groups I, II, and III, respectively. Conclusion : Clinical features of pituitary hemorrhage may differ with the radiological and immunohistopathlogical findings. Persistent symptoms are related to the chronic stage of hematoma requiring surgery for symptom relief. Neurological deficits are caused by large amount of acute hemorrhage requiring emergency operation. Silent adenoma is related to the severity of pituitary hemorrhage.

Impact of subclinical haemorrhage on the pituitary gland in patients with pituitary adenomas

“…SPAH was common in the patients with prolactinomas (46·8%), whereas CPAA was common in the patients with nonfunctioning pituitary adenomas (100%). These results coincide well with the data of previous studies, in which the incidence of SPAH has been reported to range from 9·5 to 18·1% and prolactinomas have been found to be the most frequent tumours in patients with pituitary adenomas with subclinical haemorrhage . On the other hand, CPAA is known to frequently occur in patients with nonfunctioning adenomas (66·7–84·4%) .…”

“…These results coincide well with the data of previous studies, in which the incidence of SPAH has been reported to range from 9Á5 to 18Á1% 2,4,14-16 and prolactinomas have been found to be the most frequent tumours in patients with pituitary adenomas with subclinical haemorrhage. 2,4,14 On the other hand, CPAA is known to frequently occur in patients with nonfunctioning adenomas (66Á7-84Á4%). 4,17,18 The differences in features of SPAH in patients with prolactinomas and CPAA in patients with nonfunctioning adenomas remain unclear.…”

Fluid-fluid level on magnetic resonance images may predict the occurrence of pituitary adenomas in cystic sellar-suprasellar masses

“…These results are in accordance with the previous observation that the occurrence of fluid-fluid levels within hemorrhagic pituitary tumors ranges from 48.1-55.8% (10,14). Additionally, hemorrhage within pituitary adenomas is common in patients with non-functioning adenomas and prolactinomas (9,(16)(17)(18)(19)(20)(21); although an earlier study suggests that GH-and ACTH-secreting pituitary adenomas are more likely to present apoplexy than others (22). This immunological variation may be due to the lack of specific clinical markers for non-functioning and FSH/LH tumors, which may remain undetected for many years until they become large enough to induce tumor ischemia (13,21).…”

“…In PRL and multi-functional pituitary adenomas, hemorrhage and cystic degeneration may occur due to high metabolism and relative ischemia (19). In addition, it is notable that large or rapidly growing pituitary adenomas maybe prone to hemorrhage and cyst formation (17).…”

Evaluation of clinical and magnetic resonance imaging profile of pituitary macroadenoma: A prospective study

“…In a study of 88 cases of macroadenoma by Kim et al .,[ 14 ] hemorrhage was detected in 36% cases. In another study of 83 cases by Nishi et al .,[ 15 ] hemorrhage was detected in 31% cases.…”