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Cited by 195Pituitary Gland Disorders and TreatmentsHead and Neck Surgical OncologyMeningioma and schwannoma management

Pituitary tumor apoplexy: characteristics, treatment, and outcomes

Open access
Verrees, Meg, Arafah, Baha M., Selman, Warren R.·2004·Neurosurgical Focus
DOI 10.3171/foc.2004.16.4.7
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Abstract

Pituitary tumor apoplexy is an uncommon event heralded by abrupt onset of severe headache, restriction of visual fields, deterioration of visual acuity, and weakness of ocular motility frequently coupled with clinical indications of decreased endocrine function. Hemorrhage into or necrosis of a preexisting sellar mass, usually a pituitary macroadenoma, produces an expansion of sellar contents. Compression of adjacent structures elicits the variable expression of symptoms referable to displacement of the optic nerves and chiasm and impingement of the third, fourth, and sixth cranial nerves. Damage to or destruction of the anterior pituitary leads to multiple acute and/or chronic hormone deficiencies in many patients. Medical management may be used in rare cases in which the signs and symptoms are mild and restricted to meningismus or ophthalmoplegia deemed to be stable. In patients with visual or oculomotor lability or an altered level of consciousness, expeditious surgical decompression, accomplished most commonly through a transsphenoidal approach, should be performed to save life and vision and to optimize the chance of regaining or maintaining pituitary function.

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Registry

Crossref · 10.3171/foc.2004.16.4.7

Cites

89 of 89 references verified0 citation errors · 0 not checkable

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  • Patients on dexamethasone may need to increase dexamethasone doses when enzyme-inducing AEDs are co-administered.

    “Dexamethasone is metabolized primarily by hepatic CYP3A4 (269), and patients may need to increase dexamethasone doses (268).”

    From Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [268]

    The Treatment section discusses steroid replacement for pituitary tumor apoplexy and specifies intravenous hydrocortisone, but does not address dexamethasone dose increases. Searches for dexamethasone with enzyme-inducing antiepileptic drugs and for CYP3A4 metabolism found no passage addressing the claimed interaction. Page numbers were not available in our copy. (LLM, conf=0.77)

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  • Other AEDs increase SHBG, leading to the reduced bioavailability of E2 and T, which may compromise the efficacy of hormonal treatment.

    “Other AEDs increase SHBG, leading to the reduced bioavailability of E2 and T (268), which may compromise the efficacy of hormonal treatment.”

    From Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [268]

    The Patient Outcomes and Treatment sections discuss hormone replacement after pituitary apoplexy, not antiepileptic drugs or sex hormone–binding globulin (page numbers unavailable). Searches for AEDs, SHBG, and reduced estradiol or testosterone bioavailability found no passage addressing the cited claim. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • The addition of carbamazepine, oxcarbazepine, lamotrigine, perapanel, or felbamate to DDAVP therapy can cause hyponatremia by increasing DDAVP renal responsiveness.

    “The addition of carbamazepine, oxcarbazepine, lamotrigine, perapanel, or felbamate to DDAVP therapy can cause hyponatremia by increasing DDAVP renal responsiveness (268).”

    From Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [268]

    The discussion of diabetes insipidus in the section labelled Abstract concerns pituitary apoplexy and antidiuretic-hormone transport, not DDAVP drug interactions; no page number is provided in our copy. Searches for the named antiseizure drugs, desmopressin, hyponatremia, and increased renal responsiveness found no passage addressing the claim. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • Some AEDs enhance hepatic CYP450 isoenzyme activity, accelerating the hepatic metabolism of hormonal preparations and decreasing serum concentrations of relevant hormones.

    “Some AEDs enhance hepatic CYP450 isoenzyme activity (e.g., phenytoin, carbamazepine, oxcarbazepine, and topiramade), accelerating the hepatic metabolism of hormonal preparations and decreasing serum concentrations of relevant hormones (268).”

    From Hormonal Replacement in Hypopituitarism in Adults: An Endocrine Society Clinical Practice Guideline (2016) · cites this paper as [268]

    The Patient Outcomes and Treatment sections discuss hormone deficiencies and replacement after pituitary apoplexy, but not antiepileptic drugs or drug-induced hormone metabolism. Searches for AEDs, CYP450, the named drugs, and hepatic metabolism found no passage addressing the claimed mechanism. Page numbers were not available in our copy. (LLM, conf=0.78)

    Experimental — accuracy not yet measured

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Cites

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Research works printed but not linked: 2

  1. [20]20. David NJ, Gargano FP, Glaser JS: Pituitary apoplexy in clini- cal perspective, in Glaser JS (ed): Neuro-ophthalmology. St Louis: Mosby, 1978, pp 140-165
  2. [69]69. Scheithauer BW: The pituitary and sellar region, in Sternberg SS (ed): Diagnostic Surgical Pathology. New York: Raven Press, 1989, Vol 1, pp 371-393

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Authors
Verrees, M., Arafah, B. M., & Selman, W. R.
Affiliations
University Hospitals of Cleveland (US)
ORCID
Arafah, Baha M.
Venue
Neurosurgical Focus
Publisher
Journal of Neurosurgery Publishing Group (JNSPG)
Published
2004-04
Volume
16
Issue
4
Pages
1-7
ISSN
1092-0684 (ISSN-L)
DOI
10.3171/foc.2004.16.4.7
OpenAlex
W1974760524
Semantic Scholar
e7461a7c60c48ed561f19bf2bf988e616a8d55f2
Cited by
195
References
89
Citations by year
2026: 1 · 2025: 3 · 2024: 5 · 2023: 9 · 2022: 15 · 2021: 13 · 2020: 8 · 2019: 7 · 2018: 3 · 2017: 12 · 2016: 9 · 2015: 16 · 2014: 10 · 2013: 13 · 2012: 6
FWCI
0.85
Type
journal article
Language
en
Open access
Locations
  • Neurosurgical FOCUS (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Pituitary Gland Disorders and Treatments
  • Health Sciences › Medicine › Surgery › Head and Neck Surgical Oncology
  • Health Sciences › Medicine › Epidemiology › Meningioma and schwannoma management
Keywords
pituitary macroadenoma, visual field defects, oculomotor nerve palsy, anterior pituitary insufficiency, transsphenoidal surgery, surgical decompression, medical management, visual acuity loss, treatment outcomes
MeSH terms
Adenoma, Diabetes Insipidus, Diagnosis, Differential, Humans, Pituitary Apoplexy, Pituitary Neoplasms, Radiographic Image Enhancement, Tomography, X-Ray Computed, Treatment Outcome, Intracranial Hemorrhages

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