Pituitary Apoplexy: A Retrospective Study of 33 Cases From a Single Center

Henrik Falhammar,Sofia Tornvall,Charlotte Höybye

doi:10.3389/fendo.2021.656950

Henrik Falhammar, Sofia Tornvall + Show 1 more

Open Access

https://doi.org/10.3389/fendo.2021.656950

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Abstract

PurposeAcute symptomatic pituitary apoplexy is a rare and potentially life-threatening condition. However, pituitary apoplexy can also present with milder symptoms and stable hemodynamics. Due to the rarity of this inhomogeneous condition, clinical studies are important to increase the knowledge.MethodsWe retrospectively reviewed all consecutive cases of pituitary apoplexy being admitted between January 1st, 2005 and December 31st, 2019 at the Karolinska University Hospital, Stockholm, Sweden, for symptoms, results of magnetic resonance (MRI), biochemistry, management and mortality.ResultsThirty-three patients were identified with pituitary apoplexy, 18 were men (55%) and mean age was 46.5 (17.2) years. The incidence of symptomatic pituitary apoplexy was 1.6 patients/year (0.76 patients/1,000,000 inhabitants/year). The majority presented with headache (n=27, 82%) and hormonal deficiencies (n=18, 55%), which were most frequent in men. ACTH deficiency was present in nine patients (27% but 50% of those with hormonal deficiencies). All had the characteristic findings on MRI. Only three patients (9%) required acute pituitary surgery, while eight were operated after more than one week. Seven (21%) were on antithrombotic therapy. None of the patients died in the acute course. During follow-up (7.6 ± 4.3 years) none of the hormonal deficiencies regressed and 3 patients died from non-related causes.ConclusionOur study confirmed the rarity and the symptoms of this condition. Surprisingly, only 3 patients needed acute neurosurgical intervention, perhaps due to milder cases and a general intensified treatment of precipitating factors. An early awareness and in severe cases decision on pituitary surgery is of utmost importance to avoid severe complications.

Highlights

Pituitary apoplexy is a rare condition caused by an acute or subacute hemorrhage or infarction of the pituitary gland, most often in a pituitary macroadenoma [1]
Data was collected over the 15-year-period and 33 patients were identified with pituitary apoplexy, of which 24 presented with acute symptoms of pituitary apoplexy
In this study of patients with pituitary apoplexy we found an overall incidence of 1.04 patients/1,000,000 inhabitants/year and 0.76 patients/1,000,000 inhabitants/year of acute symptomatic pituitary apoplexy

Summary

Introduction

Pituitary apoplexy is a rare condition caused by an acute or subacute hemorrhage or infarction of the pituitary gland, most often in a pituitary macroadenoma [1]. The prevalence and incidence are difficult to estimate as many subacute cases present with subtle symptoms and remain undiagnosed. Previous studies have shown that pituitary apoplexy occurs in 212% of patients with pituitary adenoma [1], while hemorrhagic infarction or “subclinical or asymptomatic apoplexy” is more frequent. Up to 25% of all pituitary adenomas display hemorrhagic and/or necrotic areas [4]. The pathophysiology of pituitary apoplexy is not known, but as pituitary adenomas have less vascularization, ischemia because of tumor growth or decreased blood supply due to an acute blood pressure fall, are among the anticipated explanations [1, 5]. The apoplexy generates a specific pattern on magnetic resonance imaging (MRI) of the pituitary with hyper- and hypointense areas in the sella turcica on T1 and T2 weighted images, respectively, suggesting apoplexy [1, 6]

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