Surgical Management of Pituitary Apoplexy

Pituitary apoplexy (PA) is an acute event related to abrupt degeneration of a pituitary adenoma. Typically the tumor infarcts and undergoes hemorrhage. The authors believe that PA occurs due to venous infarction of an adenoma and as such, there is a variable volume of hemorrhage within the tumor. Patients commonly present with hypopituitarism, sudden symptoms of subarachnoid hemorrhage, and cranial neuropathy. Cranial nerve palsies vary depending on the degree of mass effect on the cranial nerves traversing the cavernous sinus, suprasellar cistern and the parasellar region. This condition is a medical emergency and correcting pituitary dysfunction is paramount. The most critical consideration to stabilizing patients with apoplexy is related to cardiovascular collapse due to hypocortisolism. Resuscitation with stress dose steroids is essential in the management of these select patients in an emergency department setting. Once these patients have been hemodynamically stabilized, they most often proceed with transsphenoidal surgery, which is meant to rapidly decompress neural structures causing visual disturbance, ophthalmoplegia, or brain compression. Conservative management can be chosen in patients with major comorbidities and/or minimal symptoms related to mass effect.

Duke Scholars

Author Ralph Abi Hachem Rhinology and Skull Base Surgery