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Updated: May 11, 2026
07:43
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Giant necrotic pituitary apoplexy.
Andrew A Fanous1, Edward P Quigley, Steven S Chin
1Department of Neurosurgery, University of Vermont, Burlington, VT, USA.
Summary
Pituitary apoplexy, a rare complication of pituitary adenomas, can cause severe symptoms. This case highlights successful surgical treatment of a giant necrotic pituitary apoplexy, restoring vision.
Area of Science:
- Neuroendocrinology
- Neurosurgery
- Pathology
Background:
- Pituitary apoplexy is a rare but serious complication of pituitary adenomas, characterized by hemorrhage and/or necrosis.
- Symptoms range from asymptomatic to severe neurological deficits, including visual impairment and pituitary failure.
- Giant pituitary apoplexy (lesions >60mm) is exceptionally rare, posing diagnostic and therapeutic challenges.
Observation:
- A 39-year-old male presented with sudden severe headache and diplopia, indicative of pituitary apoplexy.
- MRI revealed a massive 70x60x25mm lesion, consistent with a giant pituitary macroadenoma with complete necrotic apoplexy.
- The patient had a history of nasal congestion, decreased libido, and infertility.
Findings:
- Urgent transnasal transsphenoidal surgery was performed for decompression and resection of the necrotic lesion.
- Pathological analysis confirmed necrotic pituitary apoplexy.
- The patient experienced significant visual recovery within two months post-surgery.
Implications:
- This case underscores the rarity and diagnostic complexity of giant necrotic pituitary apoplexy.
- Early surgical intervention is crucial for reversing visual deficits in pituitary apoplexy.
- Effective management of pituitary apoplexy requires a multidisciplinary approach involving neurosurgery and endocrinology.
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