====== Pituitary apoplexy epidemiology ====== ===== Incidence ===== The exact incidence of pituitary apoplexy is difficult to estimate as many cases remain undiagnosed ((Wakai S, Fukushima T, Teramoto A, Sano K. Pituitary apoplexy: its incidence and clinical significance. J Neurosurg. 1981 Aug;55(2):187-93. doi: 10.3171/jns.1981.55.2.0187. PMID: 7252541.)). ---- Some series indicate that the incidence of apoplexy in [[pituitary neuroendocrine tumor]]s is between 1% and 26% on the basis of clinical signs coupled with surgical or histopathological evidence ((Mohr G, Hardy J. Hemorrhage, necrosis, and apoplexy in pituitary neuroendocrine tumors. Surg Neurol. 1982 Sep;18(3):181-9. doi: 10.1016/0090-3019(82)90388-3. PMID: 7179072.)) ((Mohanty S, Tandon PN, Banerji AK, Prakash B. Haemorrhage into pituitary neuroendocrine tumors. J Neurol Neurosurg Psychiatry. 1977 Oct;40(10):987-91. doi: 10.1136/jnnp.40.10.987. PMID: 591978; PMCID: PMC492882.)). ---- Mohr and Hardy noted typical symptomatic pituitary apoplexy to occur in only 0.6% of patients with significant hemorrhagic and necrotic changes in 9.5% of surgical specimens. ---- In Wilson’s series, 3% of his patients with [[macroadenoma]]s had an episode of pituitary apoplexy. In another series of 560 pituitary tumors, a high incidence of 17% was found (major attack in 7%, minor in 2%, asymptomatic in 8%) ((Wakai S, Fukushima T, Teramoto A, Sano K. Pituitary Apoplexy: Its Incidence and Clinical Signifi- cance. J Neurosurg. 1981; 55:187–193)). It is common for apoplexy to be the initial presentation of a pituitary tumor ((Rovit RL, Fein JM. Pituitary Apoplexy, A Review and Reappraisal. J Neurosurg. 1972; 37:280–288)). The very low [[incidence]] of this [[complication]] hinders formulation of widespread [[guideline]]s on diagnostic and therapeutic management ((Witek P. Pituitary apoplexy: managing the life-threatening condition associated with pituitary neuroendocrine tumors. Minerva Endocrinol. 2014 Dec;39(4):245-59. Epub 2014 Jul 29. Review. PubMed PMID: 25069845.)). Frequency of intratumoral hemorrhage increases to 26% if using only MRI criteria without clinical evidence of apoplexy. However, hemorrhagic pituitary apoplexy may be fatal. Kurisu et al reported a 68-year-old man who developed pituitary apoplexy resulting in massive intracerebral hemorrhage and death 1 month later ((Kurisu K, Kawabori M, Niiya Y, Ohta Y, Mabuchi S, Houkin K. Pituitary apoplexy manifesting as massive intracerebral hemorrhage. Case report. Neurol Med Chir (Tokyo). 2012. 52(8):587-90.)) ===== Sex ===== The male-to-female predominance is 2:1. ===== Age ===== The age range is 37-57 years. Male sex, non-functioning tumor, and macroadenoma are associated with an increased risk ((Zhu X, Wang Y, Zhao X, Jiang C, Zhang Q, Jiang W, Wang Y, Chen H, Shou X, Zhao Y, Li Y, Li S, Ye H. Incidence of Pituitary Apoplexy and Its Risk Factors in Chinese People: A Database Study of Patients with pituitary neuroendocrine tumor. PLoS One. 2015 Sep 25;10(9):e0139088. doi: 10.1371/journal.pone.0139088. eCollection 2015. PubMed PMID: 26407083; PubMed Central PMCID: PMC4583273.)). ===== Covid-19 ===== see [[Covid-19 and pituitary apoplexy]]