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Pituitary Apoplexy.

Claire Briet1, Sylvie Salenave1, Jean-François Bonneville1

  • 1Service d'Endocrinologie et des Maladies de la Reproduction and Centre de Référence des Maladies Endocriniennes Rares de la Croissance (C.B., S.S., P.C.), Hôpital de Bicêtre, Assistance Publique-Hôpitaux de Paris, Le Kremlin-Bicêtre F94275, France; Service d'Endocrinologie (C.B.), Centre Hospitalier Universitaire d'Angers, Angers 49000, France; Service d'Endocrinologie (J.-F.B.), Centre Hospitalier Universitaire de Liège, Liège B4000, Belgium; Unité Mixte de Recherche S1185 (P.C.), Université Paris-Saclay, Université Paris-Sud; and Institut National de la Santé et de la Recherche Médicale Unité 1185, Faculté de Médecine Paris-Sud, Le Kremlin-Bicêtre F94276, France; and Neurosurgery, Harvard Medical School, Brigham and Women's Hospital (E.R.L.), Boston, Massachusetts 02115.

Endocrine Reviews
|September 29, 2015
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Summary
This summary is machine-generated.

Pituitary apoplexy, a rare condition, can be managed conservatively in selected patients. This approach shows promising outcomes for visual and hormonal function, challenging the traditional surgical emergency view.

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Area of Science:

  • Endocrinology
  • Neurosurgery
  • Radiology

Background:

  • Pituitary apoplexy is a rare syndrome of pituitary adenoma hemorrhage or infarction.
  • It presents with sudden headache, visual deficits, and potential hormonal insufficiency.
  • Precipitating factors include hypertension, surgery, and anticoagulant use.

Purpose of the Study:

  • To review the diagnostic and management strategies for pituitary apoplexy.
  • To evaluate the efficacy of conservative versus surgical management.

Main Methods:

  • Review of clinical presentations and diagnostic imaging (CT/MRI).
  • Analysis of outcomes comparing surgical and conservative (wait-and-see) approaches.
  • Identification of patient selection criteria for conservative management.

Main Results:

  • Pituitary apoplexy diagnosis confirmed by imaging showing hemorrhage/necrosis.
  • Conservative management is increasingly favored for selected patients without severe visual compromise or altered consciousness.
  • Evidence suggests comparable outcomes for oculomotor palsy, pituitary function, and tumor growth with conservative care.

Conclusions:

  • Pituitary apoplexy is not always a surgical emergency.
  • Conservative management offers excellent outcomes in carefully selected patients.
  • Further controlled studies are needed to definitively compare surgical and conservative treatments.