Hemorrhagic and Non-hemorrhagic Pituitary Apoplexy: Clinical Analysis

Objective: The diagnosis of hemorrhagic versus non-hemorrhagic pituitary apoplexy can be difficult as both the clinical presentation and radiographic appearance can be variable. Early identification and treatment of these patients is essential to prevent poor outcomes. This study identifies clinical characteristics of hemorrhagic and non-hemorrhagic pituitary apoplexy.

Methods: 311 consecutive patients admitted with pituitary tumors were reviewed for clinical and radiographic evidence of pituitary apoplexy. Patient demographics, comorbidities, clinical presentation, tumor characteristics, surgical therapy, complications, and outcomes were analyzed for both groups. A cohort statistical analysis was performed using Chi square, Fisher exact test, and t-test.

Results: Patients with hemorrhagic (n = 23, 57.5%) and non-hemorrhagic (n=17, 42.5%) pituitary apoplexy were similar except the hemorrhagic cohort was older (mean age 51.5 versus 40.6, p=0.03) and more hypertensive (n=16, p=0.03). Thirty-seven patients underwent surgical decompression for their pituitary apoplexy symptoms either through transcranial or endoscopic approach. There was no statistically significant difference between hemorrhagic (n=16, 43.2% endoscopic; n=4, 10.8% transcranial) and non-hemorrhagic (n=16, 43.2%, endoscopic; n=1, 2.7%, transcranial; p=0.22) apoplexy cohorts. Risks of post-operative complications were similar in both hemorrhagic (n=5: RR 1.13, 95% CI 0.59-2.1) and non-hemorrhagic cohorts (n=3: RR 0.84, 95% CI 0.31-2.3). Achievement of a good functional outcome as measured by modified Rankin scale better than 4 at last follow-up was not statistically different among cohorts (p = 0.74).

Conclusions: Hemorrhagic and non-hemorrhagic pituitary apoplexy are similar clinical entities that require prompt surgical decompression of the optic apparatus and medical therapy aimed at treating acute adrenal insufficiency.