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.