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56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

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Management and Follow-up of pituitary tumor apoplexy: a series of 27 patients

Meeting Abstract

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  • corresponding author G. Abi Lahoud - Department of Neurosurgery, Roger Salengro Hospital, Lille, France
  • B. Chevrier-Fraboulet - Department of Neuroradiology, Roger Salengro Hospital, Lille
  • R. Assaker - Department of Neurosurgery, Roger Salengro Hospital, Lille, France

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. Doc11.05.-02.04

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2005/05dgnc0185.shtml

Published: May 4, 2005

© 2005 Abi Lahoud et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective

The aim of this study is: 1- to stress on the necessity of rapid and correct diagnosis of pituitary apoplexy in order to decrease morbidity and mortality. 2- to insist on the role of a multidisciplinary management.

Methods

Retrospective study of 27 patients presenting with pituitary apoplexy: radiological, clinical and biological findings at initial presentation and at Follow-up.

Results

6 patients were known to harbour a pituitary adenoma. Radiological data showed intratumoral hemorrhage in 59% of cases, necrosis in 22% of cases and both in 19% of cases. Suprasellar extension was found in 100% of cases and laterosellar extension into cavernous sinus in 41%. Clinical presentation was one of an acute apoplexy in 74% of cases, sub-acute one in 19% of cases and silencious in the remaining 7% of cases. Clinical findings included headacke (81,5%), “chiasmatic syndrome” (74%), oculo-motor palsies (30%), alteration in consciousness (22%), nausea and vomiting (18,5%), and fever (15%). Pituitary insufficiency was found in 100% of cases. No patient presented with diabetes insipidus. Management of pituitary apoplexy was multimodal. 6 patients were treated symptomatically, 3 patients medically and 18 patients surgically. Mean Follow-up period was 30,5 months. In patients treated conservatively, MRI showed a significant decrease in tumor size and a pituitary scar between 6 and 12 months. Hypersecretion and MRI image normalized in 3 of the non-operated patients. At long term follow-up, thyreotrope deficit was noted in 61,5% of cases, corticotrope deficit in 55%, and gonadotrope deficit in 73%. The 5 cases of post-operative diabetes insipidus regressed completely. Oculo-motor palsies recuperated in all patients whatever treatment was. Favorable evolution of visual field was noted in 86,6% and of visual acuity in 87%.

Conclusions

Surgical treatment is indicated in patients with severe visual acuity loss (before day 7) or moderate visual acuity loss which didn’t recuperate within 2 weeks, in patients with oculo-motor palsies which didn’t respond to a minimum 3 weeks’ conservative treatment, in patients with severe non-remitting headacke, in case of diagnostic doubt. Conservative management has its place in the treatment of pituitary apoplexy, at least in the early stage when no severe visual loss is present and when the adenoma is somatotrope or lactotrope.