Surgery for Pituitary Tumor Apoplexy Is Associated with Rapid Headache and Cranial Nerve Improvement

Abstract

Pituitary tumor apoplexy (PTA) classically comprises sudden-onset headache, loss of vision, ophthalmoparesis, and decreased consciousness. It typically results from hemorrhage and/or infarction within a pituitary adenoma. Presentation is heterologous, and optimal management is debated. The time course of recovery of cranial nerve deficits (CNDs) and headaches is not well established. In this study, a retrospective series of consecutive patients with PTA managed at a single academic institution over a 22-year period is presented. Headaches at the time of surgery were more severe in the early and subacute surgical cohort and improved significantly within 72 h postoperatively (p < 0.01). At one year, 90% of CNDs affecting cranial nerves (CNs) 3, 4, and 6 had recovered, with no differences between early (<4 d), subacute (4–14 d), and delayed (>14 d) time-to-surgery cohorts. Remarkably, half recovered within three days. In total, 56% of CN2 deficits recovered, with the early surgery cohort including more severe deficits and recovering at a lower rate (p = 0.01). No correlation of time-to-surgery and rapidity of recovery of CNDs was observed (p = 0.65, 0.72). Surgery for PTA is associated with rapid recovery of CNDs in the early, subacute, and delayed time frames, and with rapid headache improvement in the early and subacute time frames in 50% or more of patients.

Pituitary Apoplexy in Patients with Pituitary Neuroendocrine Tumors (PitNET)

“…GH deficiency was also reported [ 109 , 128 , 168 ], whereas spontaneous acromegaly remission was reported in four papers [ 46 , 136 , 156 , 208 ] or partial improvement of acromegaly-related GH excess [ 78 ]. Long-term therapy with desmopressin for permanent diabetes insipidus was reported, as well as [ 25 , 31 , 55 , 66 , 78 , 90 , 91 , 111 , 112 , 113 , 127 , 128 , 182 ]. Microadenomas underlying PA had a better clinical (including endocrine) outcome when compared to macroadenomas which are also associated with a higher rate of multiple hormonal deficiencies [ 169 ].…”

“…Fatal outcome surrounding PA was registered as an early event, for instance, within 48 h [ 38 ] or after 5 years since initial TSS [ 91 ]. Overall, we identified 14 publications [ 35 , 36 , 38 , 60 , 62 , 90 , 91 , 92 , 100 , 133 , 182 , 187 , 216 , 221 ]. Some of the subjects were comatose at presentation [ 36 , 38 , 60 , 216 ], PA causing an intracerebral hemorrhage [ 36 ]; similarly, one case of the following is reported: fulminant heparin-induced thrombocytopenia [ 182 ]; fatal outcome 12 days following TSS due to sepsis [ 187 ]; or 3 months since PA in a patient with breast cancer [ 62 ] or leukemia [ 100 ].…”

“…Overall, we identified 14 publications [ 35 , 36 , 38 , 60 , 62 , 90 , 91 , 92 , 100 , 133 , 182 , 187 , 216 , 221 ]. Some of the subjects were comatose at presentation [ 36 , 38 , 60 , 216 ], PA causing an intracerebral hemorrhage [ 36 ]; similarly, one case of the following is reported: fulminant heparin-induced thrombocytopenia [ 182 ]; fatal outcome 12 days following TSS due to sepsis [ 187 ]; or 3 months since PA in a patient with breast cancer [ 62 ] or leukemia [ 100 ]. Interestingly, two studies reported a mortality death of 1.03% (N = 97) [ 92 ], respective of 4.6% (N = 87) [ 90 ].…”