Endocrine Abstracts

Background: Pituitary apoplexy is rare resulting from acute haemorrhagic infarction of a pituitary adenoma. Optimal management in the acute stage still remains a matter of debate.

Methods: Retrospective analysis of casenotes of patients presenting with acute apoplexy at a single neurosurgical centre between 1984 and 2009 in the United Kingdom.

Results: Fifty-five patients (35 males, mean age 52.4 (range 14–78) years, mean years of follow up 7.9 (range 0.5–25)) were identified; 45/55 (81%) had nonfunctioning adenomas, 4/55 (7.2%) acromegaly and 6/55 (11%) prolactinomas. Two patients had MEN-1 syndrome. The commonest presenting feature was acute headache (48/55, 87%), followed by diplopia (26/55, 47.2%), and visual field (VF) defects (20/55, 36%). The most frequent ocular palsy involved the 3rd nerve (21/26, 80.7%), followed by 6th nerve palsy (9/26, 34.6%) and multiple palsies (5/26, 19.2%). Of 11/55 patients had hypertension, five were on anticoagulants, five had recent major surgery and four cases occurred in patients with a known pre-existing pituitary adenoma. Forty-two percentage (23/55) of patients were treated conservatively and the remaining 32/55 (58%) had surgery; indication for surgery was deteriorating visual acuity and field defects. Patients presenting with VF defects (n=20) were more likely to undergo surgery (15/20, 75%) than to be managed expectantly (n=5/20, 25%). There was no statistically significant difference in the rates of complete or near-complete resolution of VF deficits and cranial nerve palsies between those treated conservatively and those who underwent surgical decompression. Endocrine outcomes (cortisol, thyroid hormone, GH, sex hormone deficiencies and requirement for desmopressin) were also similar in the two groups.

Conclusions: This is the largest series from a single centre in the UK of patients presenting with acute apoplexy. Patients without VF deficits or whose visual deficits are stable or improving can be managed with a conservative approach without a negative impact on neuro-ophthalmogical and endocrine outcomes.