Endocrine Abstracts

Background: Pituitary apoplexy is a rare clinical syndrome due to abrupt hemorrhaging and/or infarction of the pituitary gland, generally within a pituitary adenoma. The outcome of acute apoplexy is variable and difficult to predict. This explains why the optimal management of acute pituitary apoplexy remains controversial. The aim of our study was to investigate the clinical, hormonal and radiological characteristics of pituitary apoplexy and to determine treatment outcomes.

Methods: We performed a retrospective study of pituitary apoplexy managed at the department of endocrinology, National Institute of Nutrition over a 23-year.

Results: A series of 33 patients with a clinical diagnosis of pituitary apoplexy was reviewed. It included 16 men and 17 women aged between 21 to 73 years (mean age: 42 years). A pituitary adenoma was unknown at the time of apoplexy in twenty-eight patients. Pituitary apoplexy occurred in macroadenoma in all the cases. It was observed most frequently in non functioning adenoma, A precipitating factor was identified in ten cases. Tumor syndrome with headache of sudden was the main complaint: 81.9%, associated with decreased of visual acuity in 57.7% of cases, visual-field impairment with bitemporal hemianopsia in 18.2%. Corticotropic deficiency which is the life threatening complication was noted in 11 patients. Thyrotropic deficiency was the most common endocrine deficiency in our work (36.4%). The diagnosis of pituitary apoplexy has been confirmed by cerebral computed tomography in 6 cases and magnetic resonance imaging in 27 cases. Surgery was indicated in 61% of cases and 39% of patients received conservative medical treatment. The outcomes in terms of visual disturbances were a resolution in 86% after conservative treatment, against 100% improvement after surgery. After conservative treatment, 39% of patients normalized their pituitary function versus 65% in the group that received surgical treatment, but one patient developed diabetes insipidus and 4 patients maintained hypopituitarism with a permanent corticotropic deficiency. Three patients had tumor recurrence after surgery.

Conclusion: Pituitary apoplexy can be difficult to diagnose. It is usually related to a pituitary unknown macroadenoma. A high index of clinical suspicion is essential to diagnose this condition as prompt management may be life and vision saving. It is always used to be treated surgically; nowadays conservative management can be used in selected patients.