Pituitary Apoplexy

James K. Liu; Richard L. Rovit; William T. Couldwell

doi:10.1055/s-2001-33622

Seminars in Neurosurgery, Table of Contents

Seminars in Neurosurgery 2001; 12(3): 315-320
DOI: 10.1055/s-2001-33622

Pituitary Apoplexy

James K. Liu¹ , Richard L. Rovit² , William T. Couldwell¹

¹Department of Neurosurgery, University of Utah School of Medicine, Salt Lake City, Utah
²New York Medical College, Valhalla and New York, New York

Abstract

ABSTRACT

Pituitary apoplexy is an uncommon complication of pituitary adenomas. The syndrome is manifest by an abrupt onset of signs and symptoms associated with infarction or hemorrhage into a preexisting pituitary adenoma. The lesion swells and expands, leading to compression of local suprasellar and parasellar structures. The incidence of pituitary apoplexy ranges from 1 to 20% in surgically verified pituitary adenomas, with a slight male predominance. Most frequently, pituitary apoplexy occurs in previously undiagnosed pituitary adenomas. The diagnosis may often be confused with aneurysmal subarachnoid hemorrhage or meningitis. When pituitary apoplexy is misdiagnosed and left untreated, the neurological sequelae can be devastating, resulting in permanent blindness, coma, or death. Glucocorticoid administration and transsphenoidal decompression remain the mainstay of treatment in this acute event.

KEYWORDS

Pituitary adenoma - pituitary apoplexy - transsphenoidal surgery

Full Text

References

REFERENCES

1 Bailey P. Pathological report of a case of akromegaly, with especial reference to the lesions in the hypophysis cerebri and in the thyroid gland; and a case of hemorrhage into the pituitary. Philadelphia Med J . 1898; 1 789-792
2 Bleibtreu L. Ein Fall von Akromeglia (Zerstorung der Hypophysis durch Blutung). Munch Med Wolchenschr . 1905; 52 2079-2080
3 Brougham M, Heusner A P, Adams R D. Acute degenerative changes in adenomas of the pituitary body-with special reference to pituitary apoplexy. J Neurosurg . 1950; 7 421-439
4 Cardoso E R, Peterson E W. Pituitary apoplexy: a review. Neurosurgery . 1984; 14 363-373
5 Krisht A F, Vaphiades M, Husain M. Pituitary apoplexy. In: Krisht AF, Tindall GT, eds. Pituitary Disorders: Comprehensive Management Baltimore: Lippincott Williams & Wilkins 1999: 295-303
6 Rovit R L, Fein J M. Pituitary apoplexy: a review and reappraisal. J Neurosurg . 1972; 37 280-288
7 White W, Liu S S. Pituitary apoplexy. In: Carter L, Spetzler RF, eds. Neurovascular Surgery New York: McGraw-Hill 1994: 497-519
8 Parent A D, Bebin J, Smith R R. Incidental pituitary adenomas. J Neurosurg . 1981; 54 228-231
9 Kovacs K, Horvath E, Ezrin C. Pituitary adenomas. Pathol Annu . 1977; 2 341-342
10 Gorczyca W, Hardy J. Microadenomas of the human pituitary and their vascularization. Neurosurgery . 1988; 22 1-6
11 Henderson W R. The pituitary adenomata: a follow-up study of the surgical results in 338 cases (Dr. Harvey Cushing's series). Br J Surg . 1939; 26 811-921
12 Arafah B M, Harrington J F, Madhoun Z T, Selman W R. Improvement of pituitary function after surgical decompression for pituitary tumor apoplexy. J Clin Endocrinol Metab . 1990; 71 323-328
13 Peterson P, Christiansen K H, Lindholm J. Acute monocular disturbances mimicking optic neuritis in pituitary apoplexy. Acta Neurol Scand . 1988; 78 101-103
14 Rosenbaum R J, Houser O W, Laws E R. Pituitary apoplexy producing internal carotid artery occlusion: case report. J Neurosurg . 1977; 47 599-604
15 Ebersold M J, Laws Jr R E, Scheithauer B W, Randall R V. Pituitary apoplexy treated by transsphenoidal surgery: a clinicopathological and immunocytochemical study. J Neurosurg . 1983; 58 315-320
16 McFadzean R M, Doyle D, Rampling R, Teasdale E, Teasdale G. Pituitary apoplexy and its effect on vision. Neurosurgery . 1991; 29 669-675
17 Onesti S T, Wisniewski T, Post K D. Clinical versus subclinical pituitary apoplexy: presentation, surgical management, and outcome in 21 patients. Neurosurgery . 1990; 26 980-986
18 Cardoso E R, Peterson E W. Pituitary apoplexy and vasospasm. Surg Neurol . 1983; 20 391-395
19 Reid R L, Quigley M E, Yen S SC. Pituitary apoplexy: a review. Arch Neurol . 1985; 42 712-719
20 Bills D C, Meyer F B, Laws E R. A retrospective analysis of pituitary apoplexy. Neurosurgery . 1993; 33 602-608
21 Rovit R L. Pituitary apoplexy. In: Wilkins RH, Rengachary SR, eds. Neurosurgery New York: McGraw-Hill 1996: 1361-1366
22 Wakai S, Fukushima T, Furihata T, Sano K. Association of cerebral aneurysm with pituitary adenoma. Surg Neurol . 1979; 12 503-507
23 Pozzati E, Frank G, Nasi M T, Giuliani G. Pituitary apoplexy, bilateral carotid vasospasm, and cerebral infarction in a 15-year-old boy. Neurosurgery . 1987; 20 56-59
24 Wilkins R H. Hypothalamic dysfunction and intracranial arterial spasms. Surg Neurol . 1975; 4 472-480
25 Absalom M, Rogers K H, Roulton R J, Mazer C D. Pituitary apoplexy after coronary artery surgery. Anesth Analg . 1993; 76 648-649
26 Cooper D M, Bazaral M G, Furlan A J. Pituitary apoplexy: a complication of cardiac surgery. Ann Thorac Surg . 1986; 41 547-550
27 Slavin M L, Budabin M. Pituitary apoplexy associated with cardiac surgery. Am J Ophthalmol . 1984; 98 291-296
28 Shapiro L M. Pituitary apoplexy following coronary artery bypass surgery. J Surg Oncol . 1990; 44 66-68
29 Mohr G, Hardy J. Hemorrhage, necrosis and apoplexy in pituitary adenomas. Surg Neurol . 1982; 18 181-189
30 Dawson B H, Kothandaram P. Acute massive infarction of pituitary adenomas: a study of five patients. J Neurosurg . 1972; 37 275-279
31 Reichenthal E, Manor R S, Shalit M N. Pituitary apoplexy during carotid angiography. Acta Neurochir (Wien) . 1980; 54 25-255
32 Perpetuo F O. [Pituitary apoplexy after pneumoencefalogram]. Arq Neuropsiquiatr . 1976; 34 298-301
33 Van Wagenen P W. Hemorrhage into pituitary tumor following trauma. Ann Surg . 1932; 95 625-628
34 Alhajje A, Lambert M, Crabbe J. Pituitary apoplexy in an acromegalic patient during bromocriptine therapy: case report. J Neurosurg . 1985; 63 288-292
35 Wakai S, Fukushima T, Teramoto A, Sano K. Pituitary apoplexy: its incidence and clinical significance. J Neurosurg . 1981; 55 187-193
36 Weisberg L A. Pituitary apoplexy: association of degenerative change in pituitary adenoma with radiotherapy and detection by cerebral computed tomography. Am J Med . 1977; 63 109-115
37 David N J, Gargano F P, Glaser J S. Pituitary apoplexy in clinical perspective. Neuroophthalmology . 1975; 8 140-165
38 Sussman E B, Porro R S. Pituitary apoplexy: the role of atheromatous emboli. Stroke . 1974; 5 318-323
39 Barber S G. Hypopituitarism and artificial ventilation. Acta Endocrinol . 1979; 90 211-216
40 Tasdemiroglu E, Zuccarello M, Tew Jr M J. Recovery of vision after transcranial decompression of pituitary apoplexy characterized by third ventricular hemorrhage. Neurosurgery . 1993; 32 121-123
41 Bernstein M, Hegele R A, Gentili F. Pituitary apoplexy associated with a triple bolus test: case report. J Neurosurg . 1984; 61 586-590
42 Arafah B M, Taylor H C, Salazar R, Saadi H, Selman W R. Apoplexy of a pituitary adenoma after dynamic testing with gonadotropin-releasing hormone. Am J Med . 1989; 87 103-105
43 Morsi A, Jamal S, Silverberg J D. Pituitary apoplexy after leuprolide administration for carcinoma of the prostate. Clin Endocrinol (Oxf) . 1996; 44 121-124
44 Reznik Y, Chapon F, Lahlou N, Deboucher N, Mahoudeau J. Pituitary apoplexy of a gonadotroph adenoma following gonadotrophin releasing hormone agonist therapy for prostatic cancer. J Endocrinol Invest . 1997; 20 566-568
45 Provenzale J M, Hacein-Bey L, Taveras J M. Internal carotid artery dissection associated with pituitary apoplexy: MR findings. J Comput Assist Tomogr . 1995; 19 150-152
46 Suzuki H, Muramatsu M, Murao K, Kawaguchi K, Shimizu T. Pituitary apoplexy caused by ruptured internal carotid artery aneurysm. Stroke . 2001; 32 567-569
47 Kingdon C C, Sidhu P S, Cohen J. Pituitary apoplexy secondary to an underlying abscess. J Infect . 1996; 33 53-55
48 Liu J K, Nwagwu C, Pikus H J, Couldwell W T. Laparoscopic anterior lumbar interbody fusion precipitating pituitary apoplexy. Acta Neurochir (Wien) . 2001; 143 303-307
49 Fraioli B, Esposito V, Palma L, Cantore G. Hemorrhagic pituitary adenomas: clinicopathological features and surgical treatment. Neurosurgery . 1990; 27 741-747
50 Baker H L. The angiographic delineation of sellar and parasellar masses. Radiology . 1972; 104 67-78
51 Powell D F, Baker H L, Laws E R. The primary angiographic findings in pituitary adenomas. Radiology . 1974; 110 589-595
52 Wislocki G B. The meningeal relations of the hypophysis cerebri. Am J Anat . 1937; 61 95-129
53 Wislocki G B, King L S. The permeability of the hypophysis and the hypothalamus to vital dyes, with a study of the hypophysial vascular supply. Am J Anat . 1936; 58 421-472
54 Mohanty S, Tandon P N, Banerji A K, Prakash B. Haemorrhage into pituitary adenomas. J Neurol Neurosurg Psychiatry . 1977; 40 987-991
55 Post M JD, David N J, Glaser J S, Safran A. Pituitary apoplexy: diagnosis by computed tomography. Radiology . 1980; 134 665-670
56 Brisman M H, Katz G, Post K D. Symptoms of pituitary apoplexy rapidly reversed with bromocriptine: case report. J Neurosurg . 1996; 85 1153-1155
57 Veldhuis J D, Hammond J M. Endocrine function after spontaneous infarction of the human pituitary: report, review and reappraisal. Endocr Rev . 1980; 1 100-107