====== Pituitary apoplexy treatment ====== {{ ::pituitary_apoplexy.jpg?400|}} {{rss>https://pubmed.ncbi.nlm.nih.gov/rss/search/1NKSH3UhXTzYtdDwdwvlre4hcRZ9t030MEJbJ-7jxsFxA_R9nF/?limit=15&utm_campaign=pubmed-2&fc=20230701130125}} ---- ---- [[Pituitary apoplexy]] is a challenging condition due to its variable course, its diagnosis difficulty, and management, as gaps remain to determine the best approach to treat this condition ((Hadj Kacem F, Trimeche O, Gargouri I, Ben Salah D, Charfi N, Rekik N, Mnif F, Mnif M, Elleuch M, Abid M. Diagnosis and management of pituitary apoplexy: a Tunisian data. Chin Neurosurg J. 2023 Jul 1;9(1):17. doi: 10.1186/s41016-023-00331-6. PMID: 37391784.)) The pituitary function is consistently compromised, necessitating rapid administration of [[corticosteroid]]s and endocrine evaluation. ---- Patients with [[pituitary apoplexy]] may have a spontaneous remission of hormonal hypersecretion. If it is not an emergency, we should delay a decision to undertake surgery following [[apoplexy]] and re-evaluate hormone secretion. [[Hyponatremia]] is an acute sign of [[hypocortisolism]] in pituitary apoplexy. However, [[SIADH]] although uncommon, could appear later as a consequence of direct [[hypothalamic]] insult and requires active and individualized treatment. For this reason, closely monitoring [[sodium]] at the beginning of the episode and throughout the first week is advisable to guard against SIADH. Despite being less frequent, if [[pituitary apoplexy]] is limited to the tumor, the patient can recover pituitary function previously damaged by the undiagnosed [[macroadenoma]] ((Sanz-Sapera E, Sarria-Estrada S, Arikan F, Biagetti B. Acromegaly remission, SIADH and pituitary function recovery after macroadenoma apoplexy. Endocrinol Diabetes Metab Case Rep. 2019 Jul 15;2019(1). doi: 10.1530/EDM-19-0057. PubMed PMID: 31310082. )). ---- In the absence of [[visual deficit]]s, [[lactotroph adenoma]]s may be treated with [[bromocriptine]]. Rapid decompression is required for: sudden constriction of [[visual field]]s, severe and/or rapid deterioration of acuity, or neurologic deterioration due to [[hydrocephalus]]. Surgery in ≤7 days of pituitary apoplexy resulted in better improvement in [[ophthalmoplegia]] (100%), [[visual acuity]] (88%) and field cuts (95%) than surgery after 7 days, based on a retrospective study of 37 patients. ((Bills DC, Meyer FB, Laws ER,Jr, Davis DH, Ebersold MJ, Scheithauer BW, Ilstrup DM, Abboud CF. A retrospective analysis of pituitary apoplexy. Neurosurgery. 1993; 33:602–8; discussion 608-9)). Decompression is usually via a transsphenoidal route (transcranial approach may be advantageous in some cases). A systematic literature search was performed of [[MedLine]], [[Embase]], the [[Cochrane Library]], and the [[Web of Science]] for articles published between January 1992 and September 2014. Studies of the outcomes in consecutive patients that compared surgical intervention with non-surgical treatment for pituitary apoplexy were included. Six studies met the inclusion criteria. As compared to the non-surgically treated patients, surgically treated patients had a significantly higher rate of recovery of ocular palsy and visual field (both P<0.05). However, there was no significant difference in the recovery of visual acuity and pituitary function (P>0.05) between the two groups. The findings of this study suggest that surgical intervention should be advocated for pituitary apoplexy patients with visual field defects and ocular palsy ((Tu M, Lu Q, Zhu P, Zheng W. Surgical versus non-surgical treatment for pituitary apoplexy: A systematic review and meta-analysis. J Neurol Sci. 2016 Nov 15;370:258-262. doi: 10.1016/j.jns.2016.09.047. Review. PubMed PMID: 27772771. )). ===== Goals of surgery ===== 1. To decompress the following structures if under pressure: optic apparatus, [[pituitary gland]], [[cavernous sinus]], [[third ventricle]] (relieving [[hydrocephalus]]) 2. Obtain tissue for pathology 3. Complete removal of the tumor is usually not necessary 4. For hydrocephalus: [[ventricular drainage]] is generally required. ===== References =====