Pituitary apoplexy: a review and reappraisal

Abstract

✓ The authors report their experience with nine cases of acute pituitary apoplexy; eight had proven chromophobe adenomas, and two of these patients had the clinical stigmata of Cushing's syndrome. One patient who displayed acromegalic features was treated with x-ray, and no pathological specimen was obtained. The outstanding clinical features of acute pituitary apoplexy were sudden headache, depressed consciousness, ophthalmoplegia, meningismus, and signs of compression of the optic nerve or chiasma. Clinical or laboratory evidence of severe hypopituitarism was rare. The apoplectic syndrome was the first indication of the presence of a pituitary tumor in all nine cases. In one case anticoagulant therapy (for an acute myocardial infarction) appeared to have precipitated hemorrhage in an unrecognized chromophobe adenoma. The authors suggest that acute pituitary apoplexy is a surgical emergency resulting from sudden ischemia, necrosis, and hemorrhage when an expanding pituitary neoplasm has become impacted at the diaphragmatic notch.