PITUITARY APOPLEXY AFTER PITUITARY-FUNCTION TEST - A REPORT OF 2 CASES AND REVIEW OF THE LITERATURE

BACKGROUND Although most of pituitary apoplexy occur spontaneously, so me precipitating factors have been reported. We experienced two cases of pituitary apoplexy after a pituitary function test. METHODS In orde r to clarify the causal relation between the pituitary function test a nd apoplexy, we presented our two cases and reviewed 20 cases in the l iterature. RESULTS (Case 1) A 48-year-old man with a pituitary macroad enoma received an injection of 500 mu g thyrotropin-releasing hormone (TRH), 100 mu g gonadotropin-releasing hormone (GnRH), and 0.1U/kg ins ulin as a preoperative test of pituitary function. Fifteen minutes lat er, he complained of diminished vision and headache. (Case 2) A 54-yea r-old man with a large cystic adenoma had an administration of 500 mu g TRH and 100 mu g GnRH. Ten minutes later, he complained of blurring of his left eye and headache. Although, in both cases, CT scans showed neither intratumoral hemorrhage nor infarction, the surgical specimen showed necrotic and hemorrhagic adenoma. The patients made excellent clinical recoveries after surgical decompression. Twenty-two reports i ncluding our two cases were reviewed. In 15 cases (68%), TRH was assoc iated with apoplectic events and seemed to be the agent most likely to have an etiologic role because of its vasoactive properties. Eighteen patients (82%) had pituitary macroadenomas with suprasellar extension . In 72% of 18 surgical cases, some recovery of visual function was ob tained. CONCLUSIONS An apparent relationship between the test and the apoplectic events raises the possibility of the development of pituita ry apoplexy after a pituitary function test. Unless there is a specifi c indication, pituitary function test should be avoided especially in patients with a large pituitary tumor.