PITUITARY-ADENOMAS COMPLICATING CARDIAC-SURGERY - SUMMARY AND REVIEW OF 11 CASES

From the literature and our own experience, 11 cases of hemorrhage or infarction of a pituitary adenoma associated with cardiac surgery have been identified over a 13-year period. Males outnumbered females by 1 0 to 1. Symptoms observed were headache, lethargy, confusion, obtundat ion, unilateral ptosis, meiosis, and opthalmoplegia involving cranial nerves III, IV, and VI, visual field deficits, and hemiparesis. Diagno sis in most recent cases has been confirmed with computerized tomograp hy or magnetic resonance imaging. All patients received adrenocortical steroid therapy initially. Eight patients underwent transsphenoidal h ypophysectomy and all survived. One patient underwent decompression cr aniotomy and died. Intracranial surgery was deferred in 1 patient who survived and in another who died of a massive stroke. Residual neurolo gical deficits were noted to be either absent, minimal, or resolving i n 7 of the 9 patients who survived their initial hospitalization. Whil e numerous mechanisms have been proposed to explain the hemorrhage and necrosis of a pituitary adenoma during heart surgery, no direct cause has been clearly identified. Surgical treatment is commonly necessary since untreated pituitary apoplexy is often fatal. Transsphenoidal hy pohysectomy with decompression is the preferred method of treatment wi th a low perioperative mortality and fairly good long-term prognosis.