Pituitary apoplexy: evaluation of surgical results

ABSTRACT

This is a ten-year study comprised of 13 patients with a history of acute development of headache, nausea, or visual changes in the setting of a surgically verified haemorrhage into a pituitary adenoma. There were eight males and five females, with an average age of 39 years. Headache and vomiting were the most predominant presenting symptom in 77% of cases. Magnetic resonance imaging was a more powerful tool in the diagnosis of haemorrhage into a pituitary adenoma. Success in diagnosis was achieved in 100% of cases compared to 46% utilizing computerised tomography scanning. Improvement in visual acuity and visual field was noted in all surgically managed patients who presented with remaining vision. On the contrary, blindness at presentation carried a poorer prognosis. Only one of the three patients presenting with unilateral blindness improved to the pre ictal status. Ocular mobility abnormalities improved in all cases after surgery. It is concluded that pituitary apoplexy is a surgical emergency that needs rapid diagnosis, endocrine replacement, and early surgical decompression