Latika Sibal1, Steve G Ball1, Vincent Connolly2, Robert A James1, Philip Kane3, William F Kelly2, Pat Kendall-Taylor1, David Mathias4, Petros Perros1, Richard Quinton1, Bijay Vaidya5,6. 1. Department of Endocrinology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, UK. 2. Department of Endocrinology, The James Cook University Hospital, Middlesbrough, UK. 3. Department of Neurosurgery, The James Cook University Hospital, Middlesbrough, UK. 4. Departments of Otonasolaryngology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, UK. 5. Department of Endocrinology, The James Cook University Hospital, Middlesbrough, UK. bijay.vaidya@pms.ac.uk. 6. Department of Endocrinology, Diabetes & Vascular Medicine, Peninsula Medical School, Royal Devon & Exeter Hospital, Exeter, EX2 5DW, UK. bijay.vaidya@pms.ac.uk.
Abstract
OBJECTIVE: To review clinical presentation, management and outcomes following different therapies in patients with pituitary apoplexy. METHODS: Retrospective analysis of case-records of patients with classical pituitary apoplexy treated in our hospitals between 1983-2004. RESULTS: Forty-five patients (28 men; mean age 49 years, range 16-72 years) were identified. Only 8 (18%) were known to have pituitary adenomas at presentation. Thirty-four (81%) patients had hypopituitarism at presentation. CT and MRI identified pituitary apoplexy in 28% and 91% cases, respectively. Twenty-seven (60%) patients underwent surgical decompression, whilst 18 (40%) were managed conservatively. Median time from presentation to surgery was 6 days (range 1-121 days). Patients with visual field defects were more likely than those without these signs to be managed surgically (p = 0.01). Complete or near-complete resolution occurred in 93% (13/14), 94% (15/16) and 93% (13/14) of the surgically treated patients with reduced visual acuity, visual field deficit and ocular palsy, respectively. All patients with reduced visual acuity (4/4), visual field deficit (4/4) and ocular palsy (8/8) in the conservative group had complete or near-complete recovery. Only 5 (19%) patients in the surgical group and 2 (11%) in the conservative group had normal pituitary function at follow up. One (4%) patient in the surgical group and 4 (22%) in the conservative group had a recurrence of pituitary adenoma. CONCLUSIONS: This large series suggests that the patients with classical pituitary apoplexy, who are without neuro-ophthalmic signs or exhibit mild and non-progressive signs, can be managed conservatively in the acute stage.
OBJECTIVE: To review clinical presentation, management and outcomes following different therapies in patients with pituitary apoplexy. METHODS: Retrospective analysis of case-records of patients with classical pituitary apoplexy treated in our hospitals between 1983-2004. RESULTS: Forty-five patients (28 men; mean age 49 years, range 16-72 years) were identified. Only 8 (18%) were known to have pituitary adenomas at presentation. Thirty-four (81%) patients had hypopituitarism at presentation. CT and MRI identified pituitary apoplexy in 28% and 91% cases, respectively. Twenty-seven (60%) patients underwent surgical decompression, whilst 18 (40%) were managed conservatively. Median time from presentation to surgery was 6 days (range 1-121 days). Patients with visual field defects were more likely than those without these signs to be managed surgically (p = 0.01). Complete or near-complete resolution occurred in 93% (13/14), 94% (15/16) and 93% (13/14) of the surgically treated patients with reduced visual acuity, visual field deficit and ocular palsy, respectively. All patients with reduced visual acuity (4/4), visual field deficit (4/4) and ocular palsy (8/8) in the conservative group had complete or near-complete recovery. Only 5 (19%) patients in the surgical group and 2 (11%) in the conservative group had normal pituitary function at follow up. One (4%) patient in the surgical group and 4 (22%) in the conservative group had a recurrence of pituitary adenoma. CONCLUSIONS: This large series suggests that the patients with classical pituitary apoplexy, who are without neuro-ophthalmic signs or exhibit mild and non-progressive signs, can be managed conservatively in the acute stage.
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