Clinical features of pituitary adenomas with apoplexy in emergency situations

Abstract

  Pituitary apoplexy caused by hemorrhage or infarction in the pituitary gland is infrequent, but it requires emergency management. We retrospectively analyzed pituitary adenoma with apoplexy patients who required urgent treatment. Of the 407 patients who underwent pituitary tumor resections from 2006 to 2016 at our department, we examined the 12 pituitary adenoma cases with sudden onset and requiring emergency treatment (seven males, five females; median age 47 years). Symptoms included headache, visual acuity loss, diplopia, and hypopituitarism in five, four, three and two cases, respectively. There were 10 cases of nonfunctioning adenomas and two of prolactin‒secreting adenomas. All patients received initial hormone replacement. Endoscopic trans‒sphenoidal tumor resection was performed in all cases. The average interval from the symptoms’ onset to the consultation was 0.9 day. The average interval until the operation was 9.1 days. Presurgery symptom improvement occurred in five cases, and the symptoms resolved postsurgery in all five cases. The resected tumor specimens showed hemorrhage in 11 cases and infarction in one case. Total tumor removal was performed in 10 cases and subtotal removal in two cases. No post‒operative complications were observed. All patients returned to their daily lives after surgery; hormone replacement was continued in nine cases. Practically no tumor recurrence was observed. In cases of pituitary adenomas with apoplexy, corticosteroid administration is required to manage pituitary dysfunction, allowing symptom amelioration. The functional prognosis of pituitary adenomas with apoplexy is good if adequate tumor resection is possible, but hormone replacement is often required.