Abstract

CARRAL SAN LAUREANO, F. et al. Pituitary apoplexy: retrospective analysis of 9 patients with hypophyseal adenomas. An. Med. Interna (Madrid) [online]. 2001, vol.18, n.11, pp.32-36. ISSN 0212-7199.

Pituitary apoplexy is an acute hemorrhage or ischemia infarction of the pituitary gland, almost invariably occurring in the presence of an pituitary adenoma. Although intratumoral bleeding occur in about 9,5 to 25% of pituitary adenomas, various series suggest that clinical apoplexy may be diagnosed in about 2% to 10% of the adenomas.  In a retrospective study from 1988 to 1998 of 110 patients with hypophyseal adenomas, there were 9 cases with pituitary apoplexy, yielding an incidence of 8,2%. Their mean age was 52,4 ± 12,8 años years, with a male to female ratio of 7:2. Symptoms observed were headache (89%), sudden visual deterioration (78%), vomiting (78%) and oculomotor nerves paresis (33%). The diagnosis of pituitary apoplexy was established by computerized tomographic scans, and hypophyseal macroadenoma with intratumoral bleeding was observed in every patient.  Five patients underwent transphenoidal surgery. Improvement of visual deficit was observed in 3/4 (75%) and ocular paresis in 3/3 (100%) of affected patiens.  Four patients were treated conservatively with steroids. Two patiens who had visual deficit recovered it completely without surgery. Two hypophyseal adenomas were resolved spontaneosly after bleeding, one stayed unchanged and another presented recurrence of bleeding at six years of follow-up.  Steroid and thyroid hormone replacement therapy was required in 62,5% of patients. 

Keywords : Pituitary apoplexy; Pituitary adenomas transphenoidad surgers.