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Pituitary apoplexy natural history, complications and prognosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Akshun Kalia M.B.B.S.[2]

Overview

If left untreated, pituitary apoplexy can be an acute life threatening condition. Pituitary apoplexy may lead to a sudden decline in pituitary hormone production. The most life threatening endocrinopathy is an acute adrenal crisis. Complications of pituitary apoplexy include vision loss, optic neuritis, diplopia, ptosis, increased intracranial pressure, hypothyroidism, hypogonadism, and growth hormone deficiency. The prognosis of pituitary apoplexy depends upon presentation and initiation of therapy. Emergent application of medical and surgical treatment is associated with greater improvement in visual field defects, visual acuity, and diplopia. The outlook is good for people who are diagnosed early and treated. Patients require hormone(s) replacement therapy for life.

Natural History

If left untreated, pituitary apoplexy features depend upon the size of hemorrhage. Pituitary apoplexy is an acute life threatening condition in case of massive hemorrhage. Pituitary apoplexy may lead to a sudden decline in pituitary hormone production. The most life threatening endocrinopathy is an acute adrenal crisis. In a case of small sized hemorrhage, pituitary apoplexy may result in some temporary or permanent endocrinopathies from hypofunction of the pituitary gland.[1][2]

Complications

Complications of pituitary apoplexy can include:

Prognosis

  • Acute pituitary apoplexy can be life-threatening.
  • The mortality rate associated with pituitary apoplexy is 12.5% and without treatment, the mortality rate can reach as high as 50%.
  • Emergent application of medical and surgical treatment is associated with greater improvement in visual field defects, visual acuity, and diplopia.
  • Prognosis is good for people who are diagnosed early and treated. Patients require hormone(s) replacement therapy for life.[3][4][5][6]

References

  1. ↑ Woo HJ, Hwang JH, Hwang SK, Park YM (2010). “Clinical outcome of cranial neuropathy in patients with pituitary apoplexy”. J Korean Neurosurg Soc. 48 (3): 213–8. doi:10.3340/jkns.2010.48.3.213. PMC 2966721. PMID 21082047.
  2. ↑ Baruah, ManashP; Ranabir, Salam (2011). “Pituitary apoplexy”. Indian Journal of Endocrinology and Metabolism. 15 (7): 188. doi:10.4103/2230-8210.84862. ISSN 2230-8210.
  3. ↑ Xiao D, Wang S, Huang Y, Zhao L, Wei L, Ding C (2015). “Clinical analysis of infarction in pituitary adenoma”. Int J Clin Exp Med. 8 (5): 7477–86. PMC 4509236. PMID 26221291.
  4. ↑ Nawar RN, AbdelMannan D, Selman WR, Arafah BM (2008). “Pituitary tumor apoplexy: a review”. J Intensive Care Med. 23 (2): 75–90. doi:10.1177/0885066607312992. PMID 18372348.
  5. ↑ Randeva HS, Schoebel J, Byrne J, Esiri M, Adams CB, Wass JA (1999). “Classical pituitary apoplexy: clinical features, management and outcome”. Clin. Endocrinol. (Oxf). 51 (2): 181–8. PMID 10468988.
  6. ↑ Murad-Kejbou S, Eggenberger E (2009). “Pituitary apoplexy: evaluation, management, and prognosis”. Curr Opin Ophthalmol. 20 (6): 456–61. doi:10.1097/ICU.0b013e3283319061. PMID 19809320.

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