Download PDF
Seminars in Neurosurgery 2001; 12(3): 315-320
DOI: 10.1055/s-2001-33622
Copyright © 2002 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA. Tel.: +1(212) 584-4662

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
Further Information

Publication History

Publication Date:
27 August 2002 (online)

    Permissions and Reprints

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

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
    PubMedGoogle Scholar
  • 2 Bleibtreu L. Ein Fall von Akromeglia (Zerstorung der Hypophysis durch Blutung).  Munch Med Wolchenschr . 1905;  52 2079-2080
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 4 Cardoso E R, Peterson E W. Pituitary apoplexy: a review.  Neurosurgery . 1984;  14 363-373
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 6 Rovit R L, Fein J M. Pituitary apoplexy: a review and reappraisal.  J Neurosurg . 1972;  37 280-288
    PubMedGoogle Scholar
  • 7 White W, Liu S S. Pituitary apoplexy. In: Carter L, Spetzler RF, eds. Neurovascular Surgery New York: McGraw-Hill 1994: 497-519
    Google Scholar
  • 8 Parent A D, Bebin J, Smith R R. Incidental pituitary adenomas.  J Neurosurg . 1981;  54 228-231
    PubMedGoogle Scholar
  • 9 Kovacs K, Horvath E, Ezrin C. Pituitary adenomas.  Pathol Annu . 1977;  2 341-342
    PubMedGoogle Scholar
  • 10 Gorczyca W, Hardy J. Microadenomas of the human pituitary and their vascularization.  Neurosurgery . 1988;  22 1-6
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 13 Peterson P, Christiansen K H, Lindholm J. Acute monocular disturbances mimicking optic neuritis in pituitary apoplexy.  Acta Neurol Scand . 1988;  78 101-103
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 16 McFadzean R M, Doyle D, Rampling R, Teasdale E, Teasdale G. Pituitary apoplexy and its effect on vision.  Neurosurgery . 1991;  29 669-675
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 18 Cardoso E R, Peterson E W. Pituitary apoplexy and vasospasm.  Surg Neurol . 1983;  20 391-395
    CrossrefPubMedGoogle Scholar
  • 19 Reid R L, Quigley M E, Yen S SC. Pituitary apoplexy: a review.  Arch Neurol . 1985;  42 712-719
    PubMedGoogle Scholar
  • 20 Bills D C, Meyer F B, Laws E R. A retrospective analysis of pituitary apoplexy.  Neurosurgery . 1993;  33 602-608
    CrossrefPubMedGoogle Scholar
  • 21 Rovit R L. Pituitary apoplexy. In: Wilkins RH, Rengachary SR, eds. Neurosurgery New York: McGraw-Hill 1996: 1361-1366
    Google Scholar
  • 22 Wakai S, Fukushima T, Furihata T, Sano K. Association of cerebral aneurysm with pituitary adenoma.  Surg Neurol . 1979;  12 503-507
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 24 Wilkins R H. Hypothalamic dysfunction and intracranial arterial spasms.  Surg Neurol . 1975;  4 472-480
    PubMedGoogle Scholar
  • 25 Absalom M, Rogers K H, Roulton R J, Mazer C D. Pituitary apoplexy after coronary artery surgery.  Anesth Analg . 1993;  76 648-649
    PubMedGoogle Scholar
  • 26 Cooper D M, Bazaral M G, Furlan A J. Pituitary apoplexy: a complication of cardiac surgery.  Ann Thorac Surg . 1986;  41 547-550
    PubMedGoogle Scholar
  • 27 Slavin M L, Budabin M. Pituitary apoplexy associated with cardiac surgery.  Am J Ophthalmol . 1984;  98 291-296
    PubMedGoogle Scholar
  • 28 Shapiro L M. Pituitary apoplexy following coronary artery bypass surgery.  J Surg Oncol . 1990;  44 66-68
    PubMedGoogle Scholar
  • 29 Mohr G, Hardy J. Hemorrhage, necrosis and apoplexy in pituitary adenomas.  Surg Neurol . 1982;  18 181-189
    CrossrefPubMedGoogle Scholar
  • 30 Dawson B H, Kothandaram P. Acute massive infarction of pituitary adenomas: a study of five patients.  J Neurosurg . 1972;  37 275-279
    PubMedGoogle Scholar
  • 31 Reichenthal E, Manor R S, Shalit M N. Pituitary apoplexy during carotid angiography.  Acta Neurochir (Wien) . 1980;  54 25-255
    CrossrefPubMedGoogle Scholar
  • 32 Perpetuo F O. [Pituitary apoplexy after pneumoencefalogram].  Arq Neuropsiquiatr . 1976;  34 298-301
    PubMedGoogle Scholar
  • 33 Van Wagenen P W. Hemorrhage into pituitary tumor following trauma.  Ann Surg . 1932;  95 625-628
    PubMedGoogle Scholar
  • 34 Alhajje A, Lambert M, Crabbe J. Pituitary apoplexy in an acromegalic patient during bromocriptine therapy: case report.  J Neurosurg . 1985;  63 288-292
    CrossrefPubMedGoogle Scholar
  • 35 Wakai S, Fukushima T, Teramoto A, Sano K. Pituitary apoplexy: its incidence and clinical significance.  J Neurosurg . 1981;  55 187-193
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 37 David N J, Gargano F P, Glaser J S. Pituitary apoplexy in clinical perspective.  Neuroophthalmology . 1975;  8 140-165
    PubMedGoogle Scholar
  • 38 Sussman E B, Porro R S. Pituitary apoplexy: the role of atheromatous emboli.  Stroke . 1974;  5 318-323
    PubMedGoogle Scholar
  • 39 Barber S G. Hypopituitarism and artificial ventilation.  Acta Endocrinol . 1979;  90 211-216
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 41 Bernstein M, Hegele R A, Gentili F. Pituitary apoplexy associated with a triple bolus test: case report.  J Neurosurg . 1984;  61 586-590
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 47 Kingdon C C, Sidhu P S, Cohen J. Pituitary apoplexy secondary to an underlying abscess.  J Infect . 1996;  33 53-55
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 49 Fraioli B, Esposito V, Palma L, Cantore G. Hemorrhagic pituitary adenomas: clinicopathological features and surgical treatment.  Neurosurgery . 1990;  27 741-747
    PubMedGoogle Scholar
  • 50 Baker H L. The angiographic delineation of sellar and parasellar masses.  Radiology . 1972;  104 67-78
    PubMedGoogle Scholar
  • 51 Powell D F, Baker H L, Laws E R. The primary angiographic findings in pituitary adenomas.  Radiology . 1974;  110 589-595
    PubMedGoogle Scholar
  • 52 Wislocki G B. The meningeal relations of the hypophysis cerebri.  Am J Anat . 1937;  61 95-129
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 54 Mohanty S, Tandon P N, Banerji A K, Prakash B. Haemorrhage into pituitary adenomas.  J Neurol Neurosurg Psychiatry . 1977;  40 987-991
    CrossrefPubMedGoogle Scholar
  • 55 Post M JD, David N J, Glaser J S, Safran A. Pituitary apoplexy: diagnosis by computed tomography.  Radiology . 1980;  134 665-670
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar