Urgent endoscopic surgery is an optimal first-line therapy for Pituitary Apoplexy
Pituitary apoplexy is a syndrome of bleeding and swelling of a pituitary adenoma causing rapid onset of headache, visual loss and/or pituitary failure. Urgent surgery is generally indicated.
Pituitary apoplexy develops over hours to several days from hemorrhage and/or infarction of pituitary adenoma (typically a macroadenoma or a Rathke’s cleft cyst). Symptoms may include headache, nausea, visual loss, double vision, confusion and/or extreme fatigue. Most patients have undiagnosed hormone insufficiency prior to the apoplectic event and some have hormonal excess from a hormone-secreting adenoma such as a prolactinoma or GH-secreting adenoma causing acromegaly. Pituitary Apoplexy is best confirmed by MRI. A head CT will also show areas of bleeding or a mass in the sella in the majority of cases. Other conditions that can mimic pituitary apoplexy are a ruptured aneurysm, meningitis, a stroke, intracerebral hemorrhage and migraine headache. The primary treatment for most patients with pituitary apoplexy is urgent endoscopic endonasal surgery and intravenous administration of the stress doses of glucocorticoids (such as hydrocortisone).
Fortunately, for most patients who are treated in a timely fashion with urgent tumor removal by an experienced surgical team, the outcomes are usually quite good. A majority of patients will have recovery of visual deficits or double vision and some will have recovery of pituitary gland function. At Pacific Pituitary Disorders Center, we have one of the world’s largest experiences in endoscopic endonasal surgery. With cutting-edge technology and instrumentation and proven surgical experience of over 2000 endonasal surgeries, we make pituitary surgery safer, less invasive and more effective. Center Director and Neurosurgeon Dr. Daniel Kelly and his neurosurgical partner Dr. Garni Barkhoudarian and ENT Surgeons Drs. Chester Griffiths and Kian Karimi, have one of the largest surgical experiences treating patients with pituitary adenomas, including many iwht pituitary apoplexy.
We also have highly experienced pituitary endocrinologists, led by Dr. Katherine Araque and colleagues Drs. Pejman Cohan and Sarah Rettinger to provide tailored hormone replacement therapy. For patients with pituitary apoplexy from adenomas that cannot be completely removed with endoscopic surgery or controlled with medications, our outstanding radiation oncologists can deliver focused radiosurgery or radiotherapy to tumors to help halt adenoma growth.