Full length articlePituitary apoplexy - A single center retrospective study from the neurosurgical perspective and review of the literature

- Prominent clinical symptoms of pituitary apoplexy are sudden headache, ophthalmologic symptoms and acute hypopituitarism.
- Neurologists and neurosurgeons should be aware of endocrinological disturbances associated with pituitary apoplexy.
- Hyponatremia, nausea, vomiting and alterations of consciousness are indicators of life-threatening Addisonian crisis.
- After pituitary apoplexy, patients must be counselled to adhere to long-term endocrinological and neurosurgical follow-up.

ObjectiveThunderclap headache and visual disturbances are typical clinical features of pituitary apoplexy (PA). Because of the acute symptomatology, many patients are referred to a neurosurgical department without prior endocrinological assessment. It is the aim of the present study to analyze initial presenting symptoms, outcome and associated endocrine disturbances in a cohort of patients with pituitary apoplexy primarily seen by neurosurgeons.Patients and methodsRetrospective single-center study in a neurosurgical department. Patients' records were reviewed for clinical, neuropathological and endocrinological findings. The diagnosis of PA was based on clinical, imaging and histological findings.ResultsA total of 60 patients were studied. They were referred most often by neurologists (n = 16), and family physicians (n = 12). Only 2 patients received an endocrinological work-up prior to admission. The most frequently documented presenting symptoms were headache (n = 54), visual field defects (n = 13), reduction of visual acuity (n = 17) and/or diplopia (n = 19). An endocrinological history had rarely been taken and hormone blood tests were oftentimes incomplete or not ordered. At 3-month follow-up 18/44 patients had complete anterior hypopituitarism. At 12 months, 21/60 patients were lost to endocrinological follow-up.ConclusionsThe classic neurological symptoms of PA were well documented in our patient cohort, whereas endocrinological symptoms, especially those indicative of pituitary dysfunction were underreported. Neurologists and neurosurgeons need to be aware of the endocrinological sequelae of pituitary apoplexy in order to avoid potentially lethal complications. Patients should be counselled to adhere to long-term endocrinological and neurosurgical follow-up.