Document Detail


Pituitary apoplexy: a review of clinical presentation, management and outcome in 45 cases.
MedLine Citation:
PMID:  16010459     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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.
Authors:
Latika Sibal; Steve G Ball; Vincent Connolly; Robert A James; Philip Kane; William F Kelly; Pat Kendall-Taylor; David Mathias; Petros Perros; Richard Quinton; Bijay Vaidya
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Pituitary     Volume:  7     ISSN:  1386-341X     ISO Abbreviation:  Pituitary     Publication Date:  2004  
Date Detail:
Created Date:  2005-12-05     Completed Date:  2005-12-21     Revised Date:  2013-05-28    
Medline Journal Info:
Nlm Unique ID:  9814578     Medline TA:  Pituitary     Country:  United States    
Other Details:
Languages:  eng     Pagination:  157-63     Citation Subset:  IM    
Affiliation:
Department of Endocrinology, Newcastle University Teaching Hospitals, Newcastle upon Tyne, U.K.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adolescent
Adrenal Cortex Hormones / therapeutic use
Adult
Aged
Combined Modality Therapy
Decompression, Surgical
Ergolines / therapeutic use
Female
Humans
Hypopituitarism / complications,  diagnosis,  pathology
Magnetic Resonance Imaging
Male
Middle Aged
Pituitary Apoplexy / etiology,  pathology,  therapy*
Pituitary Gland / drug effects,  surgery
Pituitary Neoplasms / complications,  diagnosis,  pathology
Retrospective Studies
Tomography, X-Ray Computed
Treatment Outcome
Vision Disorders / diagnosis,  etiology,  pathology
Chemical
Reg. No./Substance:
0/Adrenal Cortex Hormones; 0/Ergolines; LL60K9J05T/cabergoline

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


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