Keywords
endocrine
management
pituitary adenoma
pituitary apoplexy
management
pituitary adenoma
pituitary apoplexy
How to Cite
Orrego, A., & Jácome, A. (2019). Diagnosis and management of pituitary apoplexy. Revista Colombiana De Endocrinología, Diabetes &Amp; Metabolismo, 6(3), 188–197. https://doi.org/10.53853/encr.6.3.533
Abstract
Pituitary apoplexy is characterized by ischemic infarction or hemorrhage into an adenoma. Although, it occurs spontaneously in pre-existing pituitary adenomas in most cases; hypertension, pregnancy, bromocriptine, hypothalamic releasing hormones for preoperative testing, pituitary irradiation and heart surgery have been identified as precipitating factors. Classical pituitary apoplexy is a medical emergency and rapid replacement with hydrocortisone maybe life-saving. Patients develop sudden headache, vomiting, meningeal signs, visual impairment, and may be a decrease in the level of consciousness. Neurological symptoms may or not be present, the latter involving the second, third, fourth and sixth cranial nerves. It is necessary to perform a brain MRI for diagnosis. Whether to treat surgically or conservatively is a matter of discussion, but most are inclined for the first approach. It all depends on the progression and aggressiveness of symptoms, and if so happens, surgical treatment consists in emergency sellar decompression by transsphenoidal surgery and replacement therapy with steroids. Conservative management and careful monitoring for recurrence of tumor growth, plus treatment of endocrine dysfunction are an adequate alternative when symptoms ameliorate and remain stable or disappear thereafter
References
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2. Broughan M, Heusner AP, Adams RD. Acute degenerative changes in adenoma of the pituitary body-with special reference to pituitary apoplexy. J Neurosurg. 1950;7:421-39.
3. Bailey P: Pathological report of a case of acromegaly, with special reference to the lesions in the hypophysis cerebri and in the thyroid gland; and a case of haemorrhage into the pituitary. Philadelphia Med J. 1898;1:789-792.
4. Pearce JM. On the Origins of Pituitary Apoplexy. Eur Neurol. 2015;74(1- 2):18-21.
5. Briet C, Salenave S, Bonneville JF, Laws ER, Chanson P. Pituitary Apoplexy. Endocr Rev. 2015;36(6):622-45.
6. Glezer A, Bronstein MD. Pituitary apoplexy: pathophysiology, diagnosis and management. Arch Endocrinol Metab. 2015;59(3):259-64.
7. Barkhoudarian G, Kelly DF. Pituitary Apoplexy. Neurosurg Clin N Am. 2019;30(4):457-463.
8. Singh TD, Valizadeh N, Meyer FB, et al. Management and outcomes of pituitary apoplexy. J Neurosurg. 2015;122(6):1450-7.
9. Giritharan S, Gnanalingham K, Kearney T. Pituitary apoplexy - bespoke patient management allows good clinical outcome. Clin Endocrinol (Oxf). 2016;85(3):415-22.
10. Goshtasbi K, Abiri A, Sahyouni R, et al. Visual and Endocrine Recovery Following Conservative and Surgical Treatment of Pituitary Apoplexy: A Meta-Analysis. World Neurosurg. 2019;132:33-40.
11. Sahyouni R, Goshtasbi K, Choi E, et al. Vision Outcomes in Early versus Late Surgical Intervention of Pituitary Apoplexy: Meta-Analysis. World Neurosurg. 2019;127:52-57.
12. Fernández-Balsells MM, Murad MH, Barwise A, et al. Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis. J Clin Endocrinol Metab. 2011;96(4):905-12.
13. Tu M, Lu Q, Zhu P, et al. Surgical versus non-surgical treatment for pituitary apoplexy: A systematic review and meta-analysis. J Neurol Sci. 2016;370:258-262.
14. Vicente A, Lecumberri B, Gálvez MÁ; et al. [Clinical practice guideline for the diagnosis and treatment of pituitary apoplexy]. Endocrinol Nutr. 2013;60(10):582.e1-582.e12.
15. Rajasekaran S, Vanderpump M, Baldeweg S, et al. UK guidelines for the management of pituitary apoplexy. Clin Endocrinol (Oxf). 2011;74(1):9-20.
16. Piantanida E, Gallo D, Lombardi V, et al. Pituitary apoplexy during pregnancy: a rare, but dangerous headache. J Endocrinol Invest. 2014;37(9):789-97.
17. Dahan MH, Tan SL. A primer on pituitary injury for the obstetrician gynecologist: Simmond’s disease, Sheehan’s Syndrome, traumatic injury, Dahan’s Syndrome, pituitary apoplexy and lymphocytic hypophysitis. Minerva Ginecol. 2017;69(2):190-194.
18. de Heide LJ, van Tol KM, Doorenbos B. Pituitary apoplexy presenting during pregnancy. Neth J Med. 2004;62(10):393-6.
19. Jankowski PP, Crawford JR, Khanna P, Malicki DM, Ciacci JD, Levy ML. Pituitary tumor apoplexy in adolescents. World Neurosurg. 2015;83(4):644-51.
20. Randall BR, Couldwell WT. Apoplexy in pituitary microadenomas. Acta Neurochir (Wien). 2010;152(10):1737-40.
21. McFadzean RM, Doyle D, Rampling R, Teasdale E, Teasdale G. Pituitary apoplexy and its effect on vision. Neurosurgery. 1991;29(5):669-75.
22. Dan NG, Feiner RI, Houang MT, Turner JJ. Pituitary apoplexy in association with lymphocytic hypophysitis. J Clin Neurosci. 2002;9(5):577-80.
23. Husain Q, Zouzias A, Kanumuri VV, et al. Idiopathic granulomatous hypophysitis presenting as pituitary apoplexy. J Clin Neurosci. 2014;21(3):510-2.
24. Bills DC, Meyer FB, Laws ER Jr, et al. A retrospective analysis of pituitary apoplexy. Neurosurgery. 1993;33(4):602-8.
25. Maccagnan P, Macedo CL, Kayath MJ, et al. Conservative management of pituitary apoplexy: a prospective study. J Clin Endocrinol Metab. 1995;80(7):2190-7.
26. Ayuk J, McGregor EJ, Mitchell RD, Gittoes NJ. Acute management of pituitary apoplexy--surgery or conservative management? Clin Endocrinol (Oxf). 2004;61(6):747-52.
27. Lubina A, Olchovsky D, Berezin M, Ram Z, Hadani M, Shimon I. Management of pituitary apoplexy: clinical experience with 40 patients. Acta Neurochir (Wien). 2005;147(2):151-7.
28. Bujawansa S, Thondam SK, Steele C, et al. Presentation, management and outcomes in acute pituitary apoplexy: a large single-centre experience from the United Kingdom. Clin Endocrinol (Oxf). 2014;80(3):419-24.
29. Jho DH, Biller BM, Agarwalla PK, Swearingen B. Pituitary apoplexy: large surgical series with grading system. World Neurosurg. 2014;82(5):781-90.
30. Jemel M, Kandara H, Riahi M, et al. Gestational pituitary apoplexy: Case series and review of the literature. J Gynecol Obstet Hum Reprod. 2019:101589.
31. Cinar N, Tekinel Y, Dagdelen S, et al Cavernous sinus invasion might be a risk factor for apoplexy. Pituitary. 2013;16(4):483-9.
32. Chhiber SS, Bhat AR, Khan SH, et al. Apoplexy in sellar metastasis: a case report and review of literature. Turk Neurosurg. 2011;21(2):230-4.
33. Biousse V, Newman NJ, Oyesiku NM. Precipitating factors in pituitary apoplexy. J Neurol Neurosurg Psychiatry. 2001;71(4):542-5.
34. Semple PL, Jane JA Jr, Laws ER Jr. Clinical relevance of precipitating factors in pituitary apoplexy. Neurosurgery. 2007;61(5):956-61.
35. Turgut M, Ozsunar Y, Ba?ak S, et al. Pituitary apoplexy: an overview of 186 cases published during the last century. Acta Neurochir (Wien). 2010;152(5):749-61.
36. Zayour DH, Selman WR, Arafah BM. Extreme elevation of intrasellar pressure in patients with pituitary tumor apoplexy: relation to pituitary function. J Clin Endocrinol Metab. 2004;89(11):5649-54.
37. Alzetani A, Fisher C, Costa R, Ohri SK. Ptosis postcardiac surgery: a case of pituitary apoplexy. Ann Thorac Surg. 2002;73(1):300-1.
38. Abbott J, Kirkby GR. Acute visual loss and pituitary apoplexy after surgery. BMJ. 2004;329(7459):218-9.
39. Mura P, Cossu AP, Musu M, et al. Pituitary apoplexy after laparoscopic surgery: a case report. Eur Rev Med Pharmacol Sci. 2014;18(22):3524-7.
40. Skljarevski V, Khoshyomn S, Fries TJ. Pituitary apoplexy in the setting of coronary angiography. J Neuroimaging. 2003;13(3):276-9.
41. Suga T, Kagawa S, Goto H, et al. A case of pituitary adenoma progressing to pituitary apoplexy on the occasion of cerebral angiography. No Shinkei Geka. 1996;24(5):475-9.
42. Yoshino A, Katayama Y, Watanabe T, et al. Apoplexy accompanying pituitary adenoma as a complication of preoperative anterior pituitary function tests. Acta Neurochir (Wien). 2007;149(6):557-65.
43. Yamamoto T, Yano S, Kuroda J, et al. Pituitary apoplexy associated with endocrine stimulation test: endocrine stimulation test, treatment, and outcome. Case Rep Endocrinol. 2012;2012:826901.
44. Sasagawa Y, Tachibana O, Nakagawa A, et al. Pituitary apoplexy following gonadotropin-releasing hormone agonist administration with gonadotropin-secreting pituitary adenoma. J Clin Neurosci. 2015;22(3):601-3.
45. Bakiri F, Herrera J, Riestra M, et al. Pituitary apoplexy after somatostatin analogue administration: coincidental or causative? Clin Endocrinol (Oxf). 2014;81(3):471-3.
46. Möller-Goede DL, Brändle M, Landau K, et al. Pituitary apoplexy: re-evaluation of risk factors for bleeding into pituitary adenomas and impact on outcome. Eur J Endocrinol. 2011;164(1):37-43.
47. Nagarajan DV, Bird D, Papouchado M. Pituitary apoplexy following anticoagulation for acute coronary syndrome. Heart. 2003;89(1):10.
48. Doglietto F, Costi E, Villaret AB, et al. New oral anticoagulants and pituitary apoplexy. Pituitary. 2016;19(2):232-4.
49. Maïza JC, Bennet A, Thorn-Kany M, et al. Pituitary apoplexy and idiopathic thrombocytopenic purpura: a new case and review of the literature. Pituitary. 2004;7(3):189-192.
50. Wildemberg LE, Neto LV, Niemeyer P, et al. Association of dengue hemorrhagic fever with multiple risk factors for pituitary apoplexy. Endocr Pract. 2012;18(5):e97-e101.
51. Carija R, Vucina D. Frequency of pituitary tumor apoplexy during treatment of prolactinomas with dopamine agonists: a systematic review. CNS Neurol Disord Drug Targets. 2012;11(8):1012-4.
52. Knoepfelmacher M, Gomes MC, Melo ME, et al. Pituitary apoplexy during therapy with cabergoline in an adolescent male with prolactin-secreting macroadenoma. Pituitary. 2004;7(2):83-7.
53. Sarwar KN, Huda MS, Van de Velde V, et al. The prevalence and natural history of pituitary hemorrhage in prolactinoma. J Clin Endocrinol Metab. 2013;98(6):2362-7.
54. Sibal L, Ball SG, Connolly V, et al. Pituitary apoplexy: a review of clinical presentation, management and outcome in 45 cases. Pituitary. 2004;7(3):157-163.
55. Vargas G, Gonzalez B, Guinto G et al. Pituitary apoplexy in nonfunctioning pituitary macroadenomas: a case-control study. Endocr Pract. 2014;20(12):1274-80.
56. Dubuisson AS, Beckers A, Stevenaert A. Classical pituitary tumour apoplexy: clinical features, management and outcomes in a series of 24 patients. Clin Neurol Neurosurg. 2007;109(1):63-70.
57. Kurwale NS, Ahmad F, Suri A, et al. Post operative pituitary apoplexy: preoperative considerations toward preventing nightmare. Br J Neurosurg. 2012;26(1):59-63.
58. Muthukumar N, Rossette D, Soundaram M, et al. Blindness following pituitary apoplexy: timing of surgery and neuro-ophthalmic outcome. J Clin Neurosci. 2008;15(8):873-9.
59. Bonneville F, Cattin F, Marsot-Dupuch K, et al. T1 signal hyperintensity in the sellar region: spectrum of findings. Radiographics. 2006;26(1):93-113.
60. Boellis A, di Napoli A, Romano A, et al. Pituitary apoplexy: an update on clinical and imaging features. Insights Imaging. 2014;5(6):753-62.
61. Witek P. Pituitary apoplexy: managing the life-threatening condition associated with pituitary adenomas. Minerva Endocrinol. 2014;39(4):245-59.
62. Shou XF, Wang YF, Li SQ, et al. Microsurgical treatment for typical pituitary apoplexy with 44 patients, according to two pathological stages. Minim Invasive Neurosurg. 2009;52(5-6):207-11.
63. Laws ER Jr, Iuliano SL, Cote DJ, et al. A Benchmark for Preservation of Normal Pituitary Function After Endoscopic Transsphenoidal Surgery for Pituitary Macroadenomas. World Neurosurg. 2016;91:371-5.
64. Teixeira JC, Lavrador J, Miguens J. Pituitary Apoplexy: Should Endoscopic Surgery Be the Gold Standard? World Neurosurg. 2018;111:e495-e499.
65. Almeida JP, Sanchez MM, Karekezi C, et al. Pituitary Apoplexy: Results of Surgical and Conservative Management Clinical Series and Review of the Literature. World Neurosurg. 2019. pii: S1878-8750(19)31961-8.
66. Zaidi HA, Cote DJ, Burke WT, et al. Time Course of Symptomatic Recovery After Endoscopic Transsphenoidal Surgery for Pituitary Adenoma Apoplexy in the Modern Era. World Neurosurg. 2016;96:434-439.
67. Leyer C, Castinetti F, Morange I, et al. A conservative management is preferable in milder forms of pituitary tumor apoplexy. J Endocrinol Invest. 2011;34(7):502-9.
68. Santos AB, França MM, Hirosawa RM, et al. Conservative management of pituitary tumor apoplexy. Arq Bras Endocrinol Metabol. 2011;55(5):345-8.
69. Gruber A, Clayton J, Kumar S, et al. Pituitary apoplexy: retrospective review of 30 patients--is surgical intervention always necessary? Br J Neurosurg. 2006;20(6):379-85.
70. Liu ZH, Chang CN, Pai PC, et al. Clinical features and surgical outcome of clinical and subclinical pituitary apoplexy. J Clin Neurosci. 2010;17(6):694-9.
2. Broughan M, Heusner AP, Adams RD. Acute degenerative changes in adenoma of the pituitary body-with special reference to pituitary apoplexy. J Neurosurg. 1950;7:421-39.
3. Bailey P: Pathological report of a case of acromegaly, with special reference to the lesions in the hypophysis cerebri and in the thyroid gland; and a case of haemorrhage into the pituitary. Philadelphia Med J. 1898;1:789-792.
4. Pearce JM. On the Origins of Pituitary Apoplexy. Eur Neurol. 2015;74(1- 2):18-21.
5. Briet C, Salenave S, Bonneville JF, Laws ER, Chanson P. Pituitary Apoplexy. Endocr Rev. 2015;36(6):622-45.
6. Glezer A, Bronstein MD. Pituitary apoplexy: pathophysiology, diagnosis and management. Arch Endocrinol Metab. 2015;59(3):259-64.
7. Barkhoudarian G, Kelly DF. Pituitary Apoplexy. Neurosurg Clin N Am. 2019;30(4):457-463.
8. Singh TD, Valizadeh N, Meyer FB, et al. Management and outcomes of pituitary apoplexy. J Neurosurg. 2015;122(6):1450-7.
9. Giritharan S, Gnanalingham K, Kearney T. Pituitary apoplexy - bespoke patient management allows good clinical outcome. Clin Endocrinol (Oxf). 2016;85(3):415-22.
10. Goshtasbi K, Abiri A, Sahyouni R, et al. Visual and Endocrine Recovery Following Conservative and Surgical Treatment of Pituitary Apoplexy: A Meta-Analysis. World Neurosurg. 2019;132:33-40.
11. Sahyouni R, Goshtasbi K, Choi E, et al. Vision Outcomes in Early versus Late Surgical Intervention of Pituitary Apoplexy: Meta-Analysis. World Neurosurg. 2019;127:52-57.
12. Fernández-Balsells MM, Murad MH, Barwise A, et al. Natural history of nonfunctioning pituitary adenomas and incidentalomas: a systematic review and metaanalysis. J Clin Endocrinol Metab. 2011;96(4):905-12.
13. Tu M, Lu Q, Zhu P, et al. Surgical versus non-surgical treatment for pituitary apoplexy: A systematic review and meta-analysis. J Neurol Sci. 2016;370:258-262.
14. Vicente A, Lecumberri B, Gálvez MÁ; et al. [Clinical practice guideline for the diagnosis and treatment of pituitary apoplexy]. Endocrinol Nutr. 2013;60(10):582.e1-582.e12.
15. Rajasekaran S, Vanderpump M, Baldeweg S, et al. UK guidelines for the management of pituitary apoplexy. Clin Endocrinol (Oxf). 2011;74(1):9-20.
16. Piantanida E, Gallo D, Lombardi V, et al. Pituitary apoplexy during pregnancy: a rare, but dangerous headache. J Endocrinol Invest. 2014;37(9):789-97.
17. Dahan MH, Tan SL. A primer on pituitary injury for the obstetrician gynecologist: Simmond’s disease, Sheehan’s Syndrome, traumatic injury, Dahan’s Syndrome, pituitary apoplexy and lymphocytic hypophysitis. Minerva Ginecol. 2017;69(2):190-194.
18. de Heide LJ, van Tol KM, Doorenbos B. Pituitary apoplexy presenting during pregnancy. Neth J Med. 2004;62(10):393-6.
19. Jankowski PP, Crawford JR, Khanna P, Malicki DM, Ciacci JD, Levy ML. Pituitary tumor apoplexy in adolescents. World Neurosurg. 2015;83(4):644-51.
20. Randall BR, Couldwell WT. Apoplexy in pituitary microadenomas. Acta Neurochir (Wien). 2010;152(10):1737-40.
21. McFadzean RM, Doyle D, Rampling R, Teasdale E, Teasdale G. Pituitary apoplexy and its effect on vision. Neurosurgery. 1991;29(5):669-75.
22. Dan NG, Feiner RI, Houang MT, Turner JJ. Pituitary apoplexy in association with lymphocytic hypophysitis. J Clin Neurosci. 2002;9(5):577-80.
23. Husain Q, Zouzias A, Kanumuri VV, et al. Idiopathic granulomatous hypophysitis presenting as pituitary apoplexy. J Clin Neurosci. 2014;21(3):510-2.
24. Bills DC, Meyer FB, Laws ER Jr, et al. A retrospective analysis of pituitary apoplexy. Neurosurgery. 1993;33(4):602-8.
25. Maccagnan P, Macedo CL, Kayath MJ, et al. Conservative management of pituitary apoplexy: a prospective study. J Clin Endocrinol Metab. 1995;80(7):2190-7.
26. Ayuk J, McGregor EJ, Mitchell RD, Gittoes NJ. Acute management of pituitary apoplexy--surgery or conservative management? Clin Endocrinol (Oxf). 2004;61(6):747-52.
27. Lubina A, Olchovsky D, Berezin M, Ram Z, Hadani M, Shimon I. Management of pituitary apoplexy: clinical experience with 40 patients. Acta Neurochir (Wien). 2005;147(2):151-7.
28. Bujawansa S, Thondam SK, Steele C, et al. Presentation, management and outcomes in acute pituitary apoplexy: a large single-centre experience from the United Kingdom. Clin Endocrinol (Oxf). 2014;80(3):419-24.
29. Jho DH, Biller BM, Agarwalla PK, Swearingen B. Pituitary apoplexy: large surgical series with grading system. World Neurosurg. 2014;82(5):781-90.
30. Jemel M, Kandara H, Riahi M, et al. Gestational pituitary apoplexy: Case series and review of the literature. J Gynecol Obstet Hum Reprod. 2019:101589.
31. Cinar N, Tekinel Y, Dagdelen S, et al Cavernous sinus invasion might be a risk factor for apoplexy. Pituitary. 2013;16(4):483-9.
32. Chhiber SS, Bhat AR, Khan SH, et al. Apoplexy in sellar metastasis: a case report and review of literature. Turk Neurosurg. 2011;21(2):230-4.
33. Biousse V, Newman NJ, Oyesiku NM. Precipitating factors in pituitary apoplexy. J Neurol Neurosurg Psychiatry. 2001;71(4):542-5.
34. Semple PL, Jane JA Jr, Laws ER Jr. Clinical relevance of precipitating factors in pituitary apoplexy. Neurosurgery. 2007;61(5):956-61.
35. Turgut M, Ozsunar Y, Ba?ak S, et al. Pituitary apoplexy: an overview of 186 cases published during the last century. Acta Neurochir (Wien). 2010;152(5):749-61.
36. Zayour DH, Selman WR, Arafah BM. Extreme elevation of intrasellar pressure in patients with pituitary tumor apoplexy: relation to pituitary function. J Clin Endocrinol Metab. 2004;89(11):5649-54.
37. Alzetani A, Fisher C, Costa R, Ohri SK. Ptosis postcardiac surgery: a case of pituitary apoplexy. Ann Thorac Surg. 2002;73(1):300-1.
38. Abbott J, Kirkby GR. Acute visual loss and pituitary apoplexy after surgery. BMJ. 2004;329(7459):218-9.
39. Mura P, Cossu AP, Musu M, et al. Pituitary apoplexy after laparoscopic surgery: a case report. Eur Rev Med Pharmacol Sci. 2014;18(22):3524-7.
40. Skljarevski V, Khoshyomn S, Fries TJ. Pituitary apoplexy in the setting of coronary angiography. J Neuroimaging. 2003;13(3):276-9.
41. Suga T, Kagawa S, Goto H, et al. A case of pituitary adenoma progressing to pituitary apoplexy on the occasion of cerebral angiography. No Shinkei Geka. 1996;24(5):475-9.
42. Yoshino A, Katayama Y, Watanabe T, et al. Apoplexy accompanying pituitary adenoma as a complication of preoperative anterior pituitary function tests. Acta Neurochir (Wien). 2007;149(6):557-65.
43. Yamamoto T, Yano S, Kuroda J, et al. Pituitary apoplexy associated with endocrine stimulation test: endocrine stimulation test, treatment, and outcome. Case Rep Endocrinol. 2012;2012:826901.
44. Sasagawa Y, Tachibana O, Nakagawa A, et al. Pituitary apoplexy following gonadotropin-releasing hormone agonist administration with gonadotropin-secreting pituitary adenoma. J Clin Neurosci. 2015;22(3):601-3.
45. Bakiri F, Herrera J, Riestra M, et al. Pituitary apoplexy after somatostatin analogue administration: coincidental or causative? Clin Endocrinol (Oxf). 2014;81(3):471-3.
46. Möller-Goede DL, Brändle M, Landau K, et al. Pituitary apoplexy: re-evaluation of risk factors for bleeding into pituitary adenomas and impact on outcome. Eur J Endocrinol. 2011;164(1):37-43.
47. Nagarajan DV, Bird D, Papouchado M. Pituitary apoplexy following anticoagulation for acute coronary syndrome. Heart. 2003;89(1):10.
48. Doglietto F, Costi E, Villaret AB, et al. New oral anticoagulants and pituitary apoplexy. Pituitary. 2016;19(2):232-4.
49. Maïza JC, Bennet A, Thorn-Kany M, et al. Pituitary apoplexy and idiopathic thrombocytopenic purpura: a new case and review of the literature. Pituitary. 2004;7(3):189-192.
50. Wildemberg LE, Neto LV, Niemeyer P, et al. Association of dengue hemorrhagic fever with multiple risk factors for pituitary apoplexy. Endocr Pract. 2012;18(5):e97-e101.
51. Carija R, Vucina D. Frequency of pituitary tumor apoplexy during treatment of prolactinomas with dopamine agonists: a systematic review. CNS Neurol Disord Drug Targets. 2012;11(8):1012-4.
52. Knoepfelmacher M, Gomes MC, Melo ME, et al. Pituitary apoplexy during therapy with cabergoline in an adolescent male with prolactin-secreting macroadenoma. Pituitary. 2004;7(2):83-7.
53. Sarwar KN, Huda MS, Van de Velde V, et al. The prevalence and natural history of pituitary hemorrhage in prolactinoma. J Clin Endocrinol Metab. 2013;98(6):2362-7.
54. Sibal L, Ball SG, Connolly V, et al. Pituitary apoplexy: a review of clinical presentation, management and outcome in 45 cases. Pituitary. 2004;7(3):157-163.
55. Vargas G, Gonzalez B, Guinto G et al. Pituitary apoplexy in nonfunctioning pituitary macroadenomas: a case-control study. Endocr Pract. 2014;20(12):1274-80.
56. Dubuisson AS, Beckers A, Stevenaert A. Classical pituitary tumour apoplexy: clinical features, management and outcomes in a series of 24 patients. Clin Neurol Neurosurg. 2007;109(1):63-70.
57. Kurwale NS, Ahmad F, Suri A, et al. Post operative pituitary apoplexy: preoperative considerations toward preventing nightmare. Br J Neurosurg. 2012;26(1):59-63.
58. Muthukumar N, Rossette D, Soundaram M, et al. Blindness following pituitary apoplexy: timing of surgery and neuro-ophthalmic outcome. J Clin Neurosci. 2008;15(8):873-9.
59. Bonneville F, Cattin F, Marsot-Dupuch K, et al. T1 signal hyperintensity in the sellar region: spectrum of findings. Radiographics. 2006;26(1):93-113.
60. Boellis A, di Napoli A, Romano A, et al. Pituitary apoplexy: an update on clinical and imaging features. Insights Imaging. 2014;5(6):753-62.
61. Witek P. Pituitary apoplexy: managing the life-threatening condition associated with pituitary adenomas. Minerva Endocrinol. 2014;39(4):245-59.
62. Shou XF, Wang YF, Li SQ, et al. Microsurgical treatment for typical pituitary apoplexy with 44 patients, according to two pathological stages. Minim Invasive Neurosurg. 2009;52(5-6):207-11.
63. Laws ER Jr, Iuliano SL, Cote DJ, et al. A Benchmark for Preservation of Normal Pituitary Function After Endoscopic Transsphenoidal Surgery for Pituitary Macroadenomas. World Neurosurg. 2016;91:371-5.
64. Teixeira JC, Lavrador J, Miguens J. Pituitary Apoplexy: Should Endoscopic Surgery Be the Gold Standard? World Neurosurg. 2018;111:e495-e499.
65. Almeida JP, Sanchez MM, Karekezi C, et al. Pituitary Apoplexy: Results of Surgical and Conservative Management Clinical Series and Review of the Literature. World Neurosurg. 2019. pii: S1878-8750(19)31961-8.
66. Zaidi HA, Cote DJ, Burke WT, et al. Time Course of Symptomatic Recovery After Endoscopic Transsphenoidal Surgery for Pituitary Adenoma Apoplexy in the Modern Era. World Neurosurg. 2016;96:434-439.
67. Leyer C, Castinetti F, Morange I, et al. A conservative management is preferable in milder forms of pituitary tumor apoplexy. J Endocrinol Invest. 2011;34(7):502-9.
68. Santos AB, França MM, Hirosawa RM, et al. Conservative management of pituitary tumor apoplexy. Arq Bras Endocrinol Metabol. 2011;55(5):345-8.
69. Gruber A, Clayton J, Kumar S, et al. Pituitary apoplexy: retrospective review of 30 patients--is surgical intervention always necessary? Br J Neurosurg. 2006;20(6):379-85.
70. Liu ZH, Chang CN, Pai PC, et al. Clinical features and surgical outcome of clinical and subclinical pituitary apoplexy. J Clin Neurosci. 2010;17(6):694-9.
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