Presentation, management and outcomes in acute pituitary apoplexy: a large single‐centre experience from the United Kingdom

Bujawansa, Sumudu; Thondam, S. K.; Steele, Caroline; Cuthbertson, Daniel J.; Gilkes, Catherine; Noonan, Carmel; Bleaney, C. W.; MacFarlane, I A; Javadpour, Mohsen; Daousi, Christina

doi:10.1111/cen.12307

Cited by 127 publications

(160 citation statements)

References 25 publications

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“…The sex-ratio favours the male gender which is affected in 60-67% of cases (2, 7,17,18,19). The age range extends from childhood to later life, but most cases are diagnosed in the 5th or 6th decade (10,18,20).…”

Section: Epidemiological Datamentioning

confidence: 99%

“…The most frequent type of preexisting adenoma appears to be NFPA (10), accounting for 45-82% of PA cases (2, 7,19,21,22,23). Prolactinomas and growth hormone (GH)-secreting pituitary adenomas follow, reported in 5.5-31% (2, 7, 19, 22, 23) and 7.2-25% of cases (19,23), respectively.…”

Section: Epidemiological Datamentioning

confidence: 99%

“…Prolactinomas and growth hormone (GH)-secreting pituitary adenomas follow, reported in 5.5-31% (2, 7, 19, 22, 23) and 7.2-25% of cases (19,23), respectively. The relative dominance of NFPA cases may be an overestimation as in many cases, both the endocrinological assessment and the immunohistochemical examination were available after the acute damage of the pituitary gland and the tumour, raising the possibility of missing functioning pituitary adenomas.…”

Section: Epidemiological Datamentioning

confidence: 99%

“…For many of these putative risk factors, causation has not been proved. In published series, possible precipitating factors have been found in 40% of cases (18); in others, the vast majority of cases occur spontaneously (6,7,19). The pathophysiology is not completely understood.…”

Section: Predisposing Factors and Pathogenesismentioning

confidence: 99%

“…Hydrocortisone was preferentially used in the reported series; recommended dosage regimes are based on expert opinions (107), but no objective data are available at present. The role of dexamethasone in high doses (up to 16 mg/day) instead of stress dose hydrocortisone has not been formally evaluated in acute PA, but its use has been reported in a number of cases (19,91), especially where an antioedematous effect is sought. There are no good comparative data, and a randomised controlled trial comparing dexamethasone with hydrocortisone is also required to determine if either results in a superior outcome.…”

Section: Managementmentioning

confidence: 99%

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MANAGEMENT OF ENDOCRINE DISEASE: Pituitary tumour apoplexy

Căpățînă

Inder

Karavitaki

et al. 2015

European Journal of Endocrinology

128

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Pituitary tumour apoplexy (PA) is a rare clinical syndrome that occurs as a result of acute haemorrhage and/or infarction within a frequently undiagnosed pituitary tumour. The sudden enlargement of the pituitary mass undergoing PA is responsible for a wide range of acute symptoms/signs (severe headache, visual loss, diplopia, hypopituitarism, impaired consciousness) which, together with the radiological evidence of a pituitary lesion, establish the diagnosis. The optimal care of PA requires involvement of a multidisciplinary team including endocrinologist, neurosurgeon, neuroophthalmologist and the management strategy that depends on the clinical manifestations, as well as the presence of co-morbidities. Prompt surgical decompression is initially indicated in cases with severe or progressive impairment of the visual acuity or the visual fields or with altered mental state and leads to visual and neurological recovery in most of the patients. The patients with mild, stable clinical picture (including those with isolated ocular palsies) can be managed conservatively (support of fluid and electrolyte balance and stress doses of steroids in most cases) with favourable visual and neurological outcome. Frequent reassessment is mandatory because the clinical course can be unpredictable; if progression of symptoms occurs, later elective surgery is indicated and is beneficial, especially in terms of visual outcome. The endocrinological outcome is less favourable, irrespective of the treatment option, with many patients remaining on long-term replacement therapy. Despite the above guidelines, clear proof of optimal outcomes in the form of randomised controlled trials is lacking. Regrowth of the pituitary tumour years after a PA episode is possible and patients require long-term surveillance.

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