PITUITARY APOPLEXY FOLLOWING CARDIOPULMONARY BYPASS - CONSIDERATIONS FOR A STAGED CARDIAC AND NEUROSURGICAL PROCEDURE

Pituitary apoplexy in a pre-existing pituitary tumor can result in ser ious and permanent neurologic deficits following cardiac surgical proc edures. Several factors related to the altered physiology of cardiopul monary bypass (CPB) contribute separately or in combination to the dev elopment of this syndrome. Over the last year we have encountered two such cases in whom emergency and prompt decompression of the adenoma r esulted in an improvement of the initial clinical presentation but nev ertheless persistence of residual and devastating ocular manifestation s. In the literature six similar cases have been reported following ca rdiac surgical procedures, with similar outcomes. In this report we de scribe our experience and management of these two patients, and that p ublished in the literature. We propose a possible role for a staged ca rdiac and neurosurgical procedure as a prophylactic measure in patient s with known pituitary tumor. The role of cerebral monitoring is also discussed.