Diagnosis and Treatment of Pituitary Apoplexy.

Jung, Hee Won; Choi, Kil Soo

Original Article

Journal of Korean Neurosurgical Society 1987;16(3): 737-746.

Department of Neurosurgery, College of Medicine, Seoul National University, Seoul, Korea.

ABSTRACT

Pituitary apoplexy is defined as a complex series of clinical events occurring as a consequence of the fulminant expansion of the pituitary tumor by infarction, hemorrhage, or hemorrhagic infarction of the tumor and the adjacent pituitary tissue. It is one of the entities which need neurosurgical emergency care. Its incidence was, however, reported variously in many literatures due to different diagnostic criteria. We reviewed 150 histologically proven pituitary adenoma cases, operated from January 1980 to September 1986, to select 30 cases which showed clinical or operative findings compatible with pitultary apoplexy('pituitary apoplexy in a broad sense'). Authors analyzed their incidence, presidposing factor, clinical feature, diagnosis and treatment, especially in those who showed major attack with evident enurologic deficits('pituitary apoplexy in a strict sense'). The conclusions are as follows; 1) Among the 150 cases of pituitary tumor, 30 cases (20.0%) were diagnosed as pituitary apoplexy in a broad sense. Eleven cases (7.3%) out of them showed major attack. 2) The symptoms and signs of the 11 cases with major attack were sudden headache(11 cases), visual impairment (9 cases), cavernous sinus compression signs (7 cases), nausea and vomiting (6 cases), depressed consciouness (4 cases), and meningismus (3 cases). 3) In the clinical diagnosis of pituitary apoplexy, findings of plain skull radiologic view were very helpful. 4) With the medical treatment and surgery, good results were achieved in all cases except one patient showing visual impairment. 5) As the method of surgical treatment, the transsphenoidal approach is highly recommended.

Key Words: Pituitary apoplexy; Hemorrhage; Pituitary adencme