Clinical significance of pituitary apoplexy

A retrospective analysis of 280 cases of pituitary adenoma operated on over a period of 10 years from 1985-94 revealed 15 cases (5.3%) presenting with apoplexy, though there were 48 cases in which haemorrhage in pituitary adenoma was confirmed at operation. In the apoplectic group all but one had abrupt onset of severe headache. Seven of these 15 patients had diminution of vision and ocular motility defects were detected in 5 patients. There were 5 patients of amenorrhoea/galactorrhoea syndrome and 2 had acromegalic features. In the remaining 8 patients retrospective analysis failed to reveal any conclusive evidence of pituitary dysfunction. Trans-sphenoidal surgery was performed in 9 cases and the rest had transcranial surgery. Visual acuity loss improved in most of the affected patients, residual ocular motility defects were mild. Urgent trans-sphenoidal surgery to decompress the expanding mass seems to be the preferred mode of surgery.