Document Detail


Clinical features and surgical outcome of clinical and subclinical pituitary apoplexy.
MedLine Citation:
PMID:  20400318     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
The clinical features of pituitary hemorrhage vary from asymptomatic to catastrophic. Clinical symptomatic pituitary apoplexy is a well-described syndrome characterized by sudden headaches, visual impairment, hypopituitarism and, at times, impaired consciousness. Subclinical pituitary apoplexy is characterized by minimal atypical clinical manifestations and, as a result, may be misdiagnosed or inappropriately treated. The purpose of the study was to evaluate the clinical manifestations, surgical outcome and post-operative pituitary function in patients who had clinical or subclinical pituitary apoplexy. We retrospectively identified 65 patients (30 men, 35 women; age range 21-87 years, mean age 48.4 years) who underwent transsphenoidal surgery. Of these, 25 patients were diagnosed as having clinical apoplexy, while the remaining 40 patients were classified as having subclinical pituitary apoplexy. The follow-up period ranged from 21 to 73 months (mean 44 months). Vision improved in 14 of 22 patients with clinical apoplexy (64%) and in 26 of 28 patients with subclinical apoplexy (93%) (p=0.017); the total resection rate was 57% and 42%, respectively (p=0.285). After 2 years of follow-up, hormone replacement therapy was needed in only 26% and 36% of patients, respectively (p=0.149). Our findings suggest that the incidence of subclinical pituitary apoplexy is higher than that of clinical pituitary apoplexy. Both the tumor resection rate and mean age were higher in those with clinical pituitary apoplexy, while those who had subclinical pituitary apoplexy demonstrated better visual improvement. During long-term follow-up, the need for hormonal replacement decreased in both groups.
Authors:
Zhuo Hao Liu; Chen Nen Chang; Ping Ching Pai; Kuo Chen Wei; Shih Ming Jung; Nan Yu Chen; Chi Cheng Chuang
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Publication Detail:
Type:  Journal Article     Date:  2010-04-18
Journal Detail:
Title:  Journal of clinical neuroscience : official journal of the Neurosurgical Society of Australasia     Volume:  17     ISSN:  1532-2653     ISO Abbreviation:  J Clin Neurosci     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-05-03     Completed Date:  2010-08-12     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9433352     Medline TA:  J Clin Neurosci     Country:  Scotland    
Other Details:
Languages:  eng     Pagination:  694-9     Citation Subset:  IM    
Copyright Information:
Copyright 2010 Elsevier Ltd. All rights reserved.
Affiliation:
Department of Neurosurgery, Chang Gung Memorial Hospital, Chang Gung Medical College and University, 5 Fu-Shin Street, Kwei-Shan Hsiang, Taoyuan Hsien 333, Taiwan.
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MeSH Terms
Descriptor/Qualifier:
Adult
Aged
Aged, 80 and over
Female
Follow-Up Studies
Hormones / administration & dosage
Humans
Male
Middle Aged
Pituitary Apoplexy / drug therapy,  etiology,  metabolism,  surgery*
Pituitary Neoplasms / complications,  surgery*
Postoperative Complications
Recovery of Function
Retrospective Studies
Sphenoid Sinus / pathology,  surgery*
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Hormones

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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