Introduction: Pituitary apoplexy is a rare clinical entity caused by acute hemorrhage or infarct of the pituitary gland most commonly seen in the presence of a pituitary adenoma. To further elucidate clinical characteristics and postoperative outcomes of this rare condition, we retrospectively analyzed the clinical features of patients who underwent transsphenoidal surgery for pituitary apoplexy at LAC+USC and Keck Hospital of USC. We report data on clinical presentation, surgical management, and postoperative outcomes of these patients.
Methods: Forty-four consecutive patients who underwent transsphenoidal surgery for clinically diagnosed pituitary tumor apoplexy were retrospectively analyzed for preoperative symptoms, endocrine deficits, imaging, complications, postoperative resolution of symptoms and follow-up details. Apoplexy was defined clinically and confirmed through examination of imaging, intraoperative findings, and histopathologic review.
Results: Mean age at surgery was 53.7 years. The most common preoperative clinical symptoms were headache (36 patients, 81.8%), visual loss (22, 52.3%) and cranial nerve palsy (18, 40.9%). Gross total resection was achieved in 77% of cases. Complications included 7 CSF leaks (17.5%), 4 transient DIs (10%), 1 meningitis (2.5%), 1 sinusitis (2.5%), and 1 abdominal hematoma (2.5%). Postoperative resolution of symptoms was achieved in 93% of patients with vision loss and 54% of patients with headache. Resolution of chief complaint was achieved in a mean 3.9 days. Fifteen percent of patients displayed tumor recurrence or progression over a mean follow-up time of 77 months (range 3.7 months-10.5 years).
Conclusions: Transsphenoidal surgery for pituitary tumor apoplexy is particularly effective when neuroophthalamic deficits are present. Apoplexy patients may be at an increased risk for tumor recurrence or progression and should be monitored accordingly.
Patient Care: Our retrospective review on pituitary tumor apoplexy is one of the largest single-series studies on this rare clinical condition. This research provides additional information on the clinical presentation and outcomes of patients who underwent transsphenoidal surgery for pituitary tumor apoplexy and contributes new literature supporting transsphenoidal surgery for the clinical management of apoplexy.
Learning Objectives: 1.Discuss the current literature on the clinical presentation of Pituitary Apoplexy and describe the most common presenting symptoms.
2.Describe the clinical presentations of patients with Pituitary Apoplexy within the LAC+USC and Keck Hospital of USC patient population and explain how these signs differ or support the literature.
3. Analyze the safety of transphenoidal surgery for pituitary adenoma with apoplexy within our patient population and how our series contributes to the existing pituitary apoplexy literature