Spontaneous Necrosis in Pituitary Tumours (Pituitary Apoplexy)

The clinical features and management of pituitary apoplexy

“…One month later she was re-admitted with a 5-day Ocular palsies (Symonds, 1962) (c) Internal carotid and its branches Hemiplegia (Schnitker and Lehnert, 1952;Jefferson and Rosenthal, 1959…”

Classical pituitary apoplexy: clinical features, management and outcome

“…Pituitary apoplexy is a term which describes an acute clinical syndrome, characterized by sudden onset of headache, vomiting, visual disturbance, ophthalmoplegia, and altered consciousness (Brougham et al ., 1950; Wakai et al ., 1981; Cardoso & Peterson, 1984). This constellation of findings occurs primarily in patients with pre‐existing pituitary adenomas (Rovit & Fein, 1972; Mohr & Hardy, 1982; Ebersold et al ., 1983), and can be due to extensive tumour infarction (Jefferson & Rosenthal, 1959; Conomy et al ., 1975) or haemorrhage (Brougham et al ., 1950; Uihlein et al ., 1957; Epstein et al ., 1971). The term has also been used to describe spontaneous infarction and haemorrhage within a nontumourous pituitary gland (Conomy et al ., 1975; Reid et al ., 1985) with similar clinical effects.…”

Hypothalamic-pituitary abscess

“…Indeed, the initial diagnosis in many of these cases was that of a pituitary tumour, and the true diagnosis was only discovered at operation or autopsy. The cases of Asenjo (1953) and Whalley (1952) were associated with pituitary adenomas, but the presence of sphenoid sinusitis and of pneumococci in Asenjo's case would indicate that there was true abscess formation, and not simply liquefaction due to spontaneous white infarction in a pituitary adenoma, a well recognized phenomenon recorded by Jefferson and Rosenthal (1959), and others, a process loosely spoken of by neurosurgeons as 'sterile abscess' of the pituitary. It is interesting to note that many of the cases have had a prolonged intermittent course with episodes of meningism and drowsiness, very similar to the patient reported now; the similarity is especially striking in the examples of Bouche et al (1964) and Paillas and Aymard (1956).…”