Pituitary apoplexy. Association of degenerative change in pituitary ademona with radiotherapy and detection by cerebral computed tomography.

In 14 of 300 patients with pituitary adenoma, apoplexy developed with pathologic evidence of hemorrhagic necrosis and cystic change in the tumor. In five patients, apoplexy was the initial manifestation; in eight patients, it was associated with radiotherapy. In 12 other patients with pituitary tumors, sudden clinical deterioration occurred; they had predominantly cystic tumors with minor foci of hemorrhagic necrosis. In five patients, this was associated with radiotherapy. Degenerative hemorrhagic, necrotic and cystic changes occur frequently in pituitary tumors and radiation may be potentially dangerous in these cases. To avoid precipitating episodes of sudded visual and neurologic deterioration, prior aspiration and biopsy may be performed through transphenoidal approach in those with intrasellar tumors, whereas in those with extrasellar tumors, cerebral computed tomographic scan may define pathologic features of the pituitary adenoma.