Timing of Surgery and Outcome in Pituitary Apoplexy
Pituitary apoplexy is often heralded by the occurrence of one or more of the following: sudden onset of headache, decreased visual acuity, restricted visual fields, disorders of ocular motility and altered sensorium. The outcome of pituitary apoplexy depe
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Natarajan Muthukumar
Contents
19.1
19.1
Introduction ...............................................
19.2
Visual Outcome and Timing of Surgery in Pituitary Apoplexy .............
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Outcome of Extraocular Palsy and Timing of Surgery ..............................
171
Endocrine Outcome and Timing of Surgery ...................................................
171
Mortality and Morbidity of Pituitary Apoplexy ................................
172
19.6
Recurrent Pituitary Apoplexy ..................
172
19.7
Tumour Recurrence After Pituitary Apoplexy ....................................
172
Influence of Precipitating Factors on Outcome of Pituitary Apoplexy ................................
172
Histopathological Findings and Outcome of Pituitary Apoplexy ........
173
19.10 Pituitary Apoplexy and Incidentalomas ...................................
173
19.11 Pituitary Apoplexy in Microadenomas .....................................
173
Conclusion ..............................................................
174
References ..............................................................
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19.3 19.4 19.5
19.8
19.9
Introduction
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N. Muthukumar, MCh, MNAMS, FICS, FACS, FAANS Department of Neurosurgery, Madurai Medical College, Muruganagam, 138, Anna Nagar, Madurai, TN 625 020, India e-mail: [email protected], [email protected]
Pituitary apoplexy is a relatively uncommon yet potentially life-threatening/vision-threatening clinical event caused by the rapid enlargement of a pituitary adenoma due to haemorrhage/infarction (Semple et al. 2005; Onesti et al. 1990). Pituitary apoplexy is often heralded by one or more of the following: sudden onset of headache, decreased visual acuity, restriction of visual fields, disorders of ocular motility and altered sensorium. Most often (≈ 80 %), it occurs in patients with no previous history of pituitary tumour, and in most cases (≈ 96 %), no precipitating factors could be identified (Semple et al. 2005). The outcome of pituitary apoplexy depends upon the correct diagnosis and early appropriate treatment. This chapter will deal with the outcome of surgery for pituitary apoplexy, especially, with special reference to the timing of surgery.
19.2
Visual Outcome and Timing of Surgery in Pituitary Apoplexy
The incidence of visual impairment in pituitary apoplexy is variable. In a large series of pituitary apoplexy reported by Semple and colleagues, impairment of visual acuity was found in 56 % of patients, visual field defects were found in 34 % of patients and 10 % of patients presented with bilateral blindness (Semple et al. 2005).
M. Turgut et al. (eds.), Pituitary Apoplexy, DOI 10.1007/978-3-642-38508-7_19, © Springer-Verlag Berlin Heidelberg 2014
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Woo and colleagues studied the visual outcome in patients with pituitary apoplexy (Woo et al. 2010). In their study of 359 patients with pituitary tumours, pituitary apoplexy occurred in 3.3 % (Woo et al. 2010). Visual acuity improved in 91.6 % of patients and visual field defect
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