Endocrine Abstracts

We report 28 patients (21M 7F; 17-86y) with pituitary apoplexy presenting between 1988 and 2004. Presenting features included: headache in 25 patients, 'collapse' in 3, vomiting in 13, complete blindness in 4, decreased visual acuity in 13, visual field loss in 12 and ophthalmoplegia in 16. Only 4 had no initial visual deficit. Predisposing factors included a known pituitary tumour in 4 patients, anticoagulant therapy in 3 patients and ITP in 1 patient. CT was initial imaging in 20: 3 of such scans were initially reported as 'normal' and a further 9 as pituitary tumour only, with no haemorrhage.

There was one early death in a patient with multiple co-morbidities. 10 patients proceeded to early pituitary surgery and 17 were managed conservatively. 4 patients were completely blind at presentation; 1of these had surgery, but only 1 patient in the conservative group regained useful vision. Of the remaining 19 patients with visual deficits, 9 (2 surgical) recovered fully and 10 (6 surgical) partially. At latest follow-up the following pituitary deficiencies were identified: ACTH 19; TSH 18; gonadotrophins 17; diabetes insipidus 7. Follow-up imaging showed reduction in the size of the pituitary mass in 20 patients (16 had been conservatively treated). At follow-up recurrence was observed in 7 cases (6 surgical; 1 conservative); subsequent therapy included radiotherapy in 5 and repeat surgery in 2 cases.

Summary. Pituitary apoplexy is associated with a high risk of subsequent hypopituitarism. The visual prognosis for those presenting with blindness is poor. Lesser degrees of visual loss and opthalmoplegia generally recover even with conservative management. There was no evidence that those patients managed surgically had a better outcome. Early neurosurgical intervention may not be required in most patients presenting with pituitary apoplexy. Our data also indicate the limitation of relying on CT as first line imaging.