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Pituitary apoplexy: A review of clinical presentation, management and outcome in 45 cases

Lookup NU author(s): Dr Latika Sibal, Dr Stephen Ball, Dr Vincent Connolly, Dr Robert James, Philip Kane, Dr William Kelly, Professor Pat Kendall-Taylor, David Mathias, Dr Petros Perros, Dr Richard Quinton, Dr Bijayeswar Vaidya

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Abstract

Objective: To review clinical presentation, management and outcomes following different therapies in patients with pituitary apoplexy. Methods: Retrospective analysis of case-records of patients with classical pituitary apoplexy treated in our hospitals between 1983-2004. Results: Forty-five patients (28 men; mean age 49 years, range 16-72 years) were identified. Only 8 (18%) were known to have pituitary adenomas at presentation. Thirty-four (81%) patients had hypopituitarism at presentation. CT and MRI identified pituitary apoplexy in 28% and 91% cases, respectively. Twenty-seven (60%) patients underwent surgical decompression, whilst 18 (40%) were managed conservatively. Median time from presentation to surgery was 6 days (range 1-121 days). Patients with visual field defects were more likely than those without these signs to be managed surgically (p = 0.01). Complete or near-complete resolution occurred in 93% (13/14), 94% (15/16) and 93% (13/14) of the surgically treated patients with reduced visual acuity, visual field deficit and ocular palsy, respectively. All patients with reduced visual acuity (4/4), visual field deficit (4/4) and ocular palsy (8/8) in the conservative group had complete or near-complete recovery. Only 5 (19%) patients in the surgical group and 2 (11%) in the conservative group had normal pituitary function at follow up. One (4%) patient in the surgical group and 4 (22%) in the conservative group had a recurrence of pituitary adenoma. Conclusions: This large series suggests that the patients with classical pituitary apoplexy, who are without neuro-ophthalmic signs or exhibit mild and non-progressive signs, can be managed conservatively in the acute stage. © Springer Science + Business Media, Inc. 2005.


Publication metadata

Author(s): Sibal L, Ball SG, Connolly V, James RA, Kane P, Kelly WF, Kendall-Taylor P, Mathias D, Perros P, Quinton R, Vaidya B

Publication type: Article

Publication status: Published

Journal: Pituitary

Year: 2004

Volume: 7

Issue: 3

Pages: 157-163

ISSN (print): 1386-341X

ISSN (electronic): 1573-7403

Publisher: Springer New York LLC

URL: http://dx.doi.org/10.1007/s11102-005-1050-3

DOI: 10.1007/s11102-005-1050-3

PubMed id: 16010459


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