CONSERVATIVE MANAGEMENT OF PITUITARY APOPLEXY - A PROSPECTIVE-STUDY

A prospective study was conducted to evaluate the usefulness and limit ations of conservative treatment in patients with pituitary apoplexy. Twelve patients presenting sudden headache, visual Impair ment, or oph thalmoplegia had the diagnosis of pituitary apoplexy established by co mputerized tomographic scans. Initially, 11 patients received iv dexam ethasone (2.0-16.0 mg/day). Surgery was indicated when dexamethasone f ailed to improve visual or consciousness impairment. Among the 7 patie nts who were treated conservatively, ophthalmoplegia recovered complet ely in 6 and improved in 1. Follow-up computerized tomographic scans s howed resolution of the tumor in 4 patients and residual masses in 3 p atients who were treated conservatively. Five patients had surgery and experienced improvement of vision and consciousness. Follow-up comput erized tomographic scans showed residual masses in ail surgical patien ts. Recurrences were observed in 2 patients, one in each group. The pr evalence of pituitary deficiencies in the conservative group (9 of 17) was similar to that of the surgical group (3 of 14), but when only pa tients whose tumors were resolved by the apoplexy were analyzed, a sig nificantly higher prevalence (8 of 12) was observed (P = 0.02). A retr ospective analysis of presenting clinical and computerized tomography data on the basis of the response to dexamethasone showed that visual impairment did not improve during treatment with dexamethasone, wherea s the presence of a large hypodense area within the tumor predicted co mplete tumor resolution. These results support conservative management of pituitary apoplexy in patients who are selected on the basis of cl inical and tomographic findings.