, Volume 21, Issue 2, pp 138–144 | Cite as

Apoplexy in nonfunctioning pituitary adenomas

  • Luiz Eduardo Wildemberg
  • Andrea Glezer
  • Marcello D. Bronstein
  • Mônica R. Gadelha


Pituitary apoplexy is an uncommon event, occurring due to the infarction and/or haemorrhage usually of a previously unknown pituitary adenoma. It can occur in all adenoma subtypes but is more common in nonfunctioning pituitary adenomas. The physiopathology is not completely clear, and precipitating factors, such as major surgeries, anticoagulant use or pituitary dynamic tests, can be found in up to 40% of patients. The clinical presentation is characterized by a rapid onset with a headache as the main symptom, but visual disturbances can also be present as well as meningism and intracranial hypertension. The diagnosis is based on imaging evaluations, mainly using magnetic resonance imaging, which can show various patterns depending on the timeframe following the occurrence of the apoplectic event. Pituitary hormonal deficits are also common, and the evaluation of hormonal levels is mandatory. Pituitary apoplexy can be managed by surgery or conservative treatment, and a multidisciplinary team is essential for the decision-making process. The outcome is usually positive with both surgical and conservative approaches, but surveillance is needed due to the risk of re-bleeding or tumour recurrence.


Nonfunctioning pituitary adenomas Apoplexy Pituitary apoplexy 


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Luiz Eduardo Wildemberg
    • 1
    • 2
  • Andrea Glezer
    • 3
  • Marcello D. Bronstein
    • 3
  • Mônica R. Gadelha
    • 1
    • 2
  1. 1.Neuroendocrinology Research Center/Endocrinology Division, Medical School and Hospital Universitário Clementino Fraga FilhoUniversidade Federal do Rio de JaneiroRio de JaneiroBrazil
  2. 2.Neuroendocrinology DivisionInstituto Estadual do Cérebro Paulo NiemeyerRio de JaneiroBrazil
  3. 3.Neuroendocrine Unit, Division of Endocrinology and Metabolism, Hospital das ClinicasUniversity of Sao Paulo Medical SchoolSão PauloBrazil

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