An investigation on clinical typing of pituitary apoplexy based on the analysis of pathologic, image, and clinical manifestations

Abstract

Sixty-one patients suffering from pituitary apoplexy(PA)were mainly diagnosed according to pathologic findings, and were collected from case record, pathology, and MRI databases. They were classified into 4 types according to the clinical condition: the insidious type was characterized with only positive pathological findings; the asymptomatic type had both positive pathologic and MRI findings; the subacute type had PA associated symptoms longer than 2 weeks; and the acute type had PA associated symptoms for 2 weeks or less. The latter 2 types had positive pathological and MRI findings additionally. The basic lesions, acute or chronic symptoms, endocrinopathies and MRI findings were compared among 4 types. Results showed as followed. In all patients, there were headache(60.7%), blurred vision(55.7%), vomiting(21.3%), and dizziness(14.8%). Apoplexy associated symptoms comprised severe headache(24.6%), rapid vision loss(29.5%), and blepharopotosis or diplopia(9.83%). Insidious, asymptomatic, subacute, and acute types were composed of 15(24.6%), 9(14.8%), 19(31.1%), and 18(29.5%)cases, respectively. Aging and intracranial space-occupying symptoms as first complaint showed increasing trend from mild to severe types(both P<0.05), while in chronic course it showed decreasing trend(P<0.05). Acute massive symptoms(P<0.01), and non-functional tumor(P<0.01)in the 2 clinical types were much more frequent than in the two mild types. Half or more pituitary-target glands showed impaired functions in each type, and the impairment showed increasing trend through mild to severe types(P<0.01). The present study provided a brief typing system in order to expand PA concept to a wider span covering various conditions. Some differences in tumor composition and endocrinopathies existed among the four types. (Chin J Endocrinol Metab, 2015, 31: 524-527) Key words: Pituitary apoplexy; Pituitary tumor; Hypopituitarism; Magnetic resonance imaging