Hemorrhage into pituitary adenomas

The clinical and pathologic features of pituitary apoplexy were evaluated within the last 100 consecutive pituitary tumors surgically treated at this institution. From this group, ten tumor specimens exhibited pathologically verifiable hemorrhagic necrosis, including six with classic apoplectic onset; the hemorrhage in four patients was asymmetric. The tumors of symptomatic patients were large, with suprasellar and parasellar extension readily identifiable by neuroradiologic examination. All tumors within this group were chromophobic adenomas by light microscopy, and each of these tumors microscopically exhibited a sinusoidal arrangement with very prominent vascularity. Comparatively, those tumors with asymptomatic hemorrhage were all intrasellar and were encountered in younger patients who had exhibited prior endocrine disturbances. By light microscopy, two of these asymptomatic lesions were chromophobic and two were acidophilic adenomas. In contrast with larger tumors, however, increased vascularity or sinusoidal patterns were not a prominent feature within this group. Our experience suggests hemorrhage within pituitary tumors is a common event, but symptomatic bleeding generally occurs in older patients whose larger tumors contain a pathologic vascular predisposition. Urgent surgical decompression (usually transsphenoidal) in symptomatic patients produced great neurologic improvement in each case.