PITUITARY APOPLEXY

Pituitary apoplexy results from necrosis or haemorrhage of a pituitary adenoma. This rare complication occurs in 2 to 10% of operated adenom as. The acute form results from massive intrapituitary bleeding leadin g to violent headache, meningeal signs, impaired conscience and ophtha lmology signs, basically bilateral blindness. Associated signs are fre quent including paralysis of the oculomotor nerves, epilepsy seizure, hemiplegia. Diabetes insipidis is exceptional. In less acute forms, th e sudden nature of the headache and ophthalmology signs can suggest di agnosis. Standard X-ray reveals destruction of the sella turcica. Comp uted tomography shows either a haematoma or a cystic cavity in the pit uitary gland which must be perfectly described together with the integ rity of the bone structures due to the risk of lysis. Magnetic resonan ce imaging is an essential technique which can be used to describe the volume and suprasellar extension of the tumour, its texture, possible compression of adjacent structures and determine the age of the haemo rrhage. This imaging technique can also isolate rare optochiasmatic ap oplexia requiring intracranial evacuation. Emergency surgery is mandat ory for most all authors. Rhinal -septal decompression is usually used , but the intracranial route may be preferred for very large suprasell ar tumours. Medical treatment alone may be successful for small prolac tin adenomas. Outcome depends on the time lapse to decompression. Opti c nerve recovery is usually possible if the delay is less than 7 days. Cranial nerve recovery is less dependent on the time interval. In all cases hormone substitution is required.