Review Of Apoplectic Pituitary Macroadenomas In A Neurosurgical Centre

Abstract

Introduction: Pituitary apoplexy is potentially disastrous, causing severe headache, sudden visual decline, and loss of consciousness. Emergency surgery and expert care would save life and vision. This study examined the presentation, treatment and outcome of patients with pituitary macro-adenomas with apoplexy. Methodology: A retrospective review of case folders of 26 clinically, radiologically and histologically confirmed apoplectic pituitary macroadenomas out of 100 pituitary macroadenomas managed at Memfys Hospital, Enugu Nigeria. Data were collected over a 20 -year period. The age, sex, symptoms, tumor diameter, and post-operative outcomes were recorded. Results: Mean age was 49.4 years with male to female ratio of 1.9:1. Commonest symptom was headache (22 patients [84.4%]. Visual acuity in the better eye was NPL in eight patients (30.8%), none 6/6 or 6/9. Nineteen patients had non-functional tumors. Average tumor diameter was 4.1cm. Hormonal derangement occurred in 21 patients (80.7%).  Gross total resection was achieved in 16 patients. Four patients (15.38%) died. Four patients had visual acuity of 6/6 at six months post-operatively. Glasgow coma score was 15/15 pre-operatively in 80.8%, and post-operatively in 95.4% of patients. Commonest tumor type was basophil adenoma, and commonest functional tumor was prolactinoma. Fourteen patients had diabetes insipidus. Conclusion: Pituitary apoplexy worsens the profile of patients with pituitary tumors. Surgery would save life and restore vision.