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Nonfunctioning Pituitary Tumour Apoplexy

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Pituitary Apoplexy

Abstract

Nonfunctioning pituitary tumours account for one-third of all pituitary neoplasms, with an incidence of 7–9 new cases/106 every year. They are slow-growing benign monoclonal adenomas that do not cause any hormone hypersecretion syndromes. Symptoms arise from local compression of normal pituitary tissue and surrounding structures. The aim of treatment is the preservation of residual pituitary function and alleviation of local compressive mass effects. The available published series show that nonfunctioning adenomas constitute the underlying diagnosis in 45 % of patients with pituitary apoplexy. Apoplexy occurs more often in macroadenomas, men and with antithrombotic use. Headache, ophthalmoplegia, reduced visual acuity and visual filed defects are common presenting features. ACTH, TSH and gonadotropin deficiencies are frequently present and need to be assessed biochemically in patients with suspected pituitary apoplexy. A low serum prolactin at presentation has been linked with the severity of hypopituitarism postsurgical decompression. Patients with nonfunctioning pituitary adenomas who present with apoplexy have reduced 5-year rates of tumour regrowth (11 %) compared to non-apoplectic surgically treated nonirradiated nonfunctioning pituitary adenomas (18–34 % in different series). In those patients operated for pituitary apoplexy, tumour recurrence seems to be more common in patients with residual post-operative tumour.

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Abbreviations

ACTH:

Adrenocorticotropic hormone

CT:

Computerized tomography

FSH:

Follicle-stimulating hormone

GH:

Growth hormone

IGF-1:

Insulin-like growth factor 1

LH:

Luteinizing hormone

MRI:

Magnetic resonance imaging

NFPAs:

Nonfunctioning pituitary adenomas

PRL:

Prolactin

TSH:

Thyroid-stimulating hormone

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Authors and Affiliations

  1. Department of Endocrinology, Royal Free London NHS Foundation Trust, Pond Street, Hampstead, London, NW3 2QG, UK

    Aikaterini Theodoraki MD, MRCP & Mark P. J. Vanderpump MD, FRCP

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  1. Aikaterini Theodoraki MD, MRCP
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  2. Mark P. J. Vanderpump MD, FRCP
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Correspondence to Mark P. J. Vanderpump MD, FRCP .

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Editors and Affiliations

  1. Department of Neurosurgery, Adnan Menderes University, School of Medicine, Aydin, Turkey

    Mehmet Turgut

  2. Department of Neurosurgery, All India Institute of Medical Sciences Neurosciences Center (AIIMS), New Delhi, India

    Ashok Kumar Mahapatra

  3. The Victor Horsley Nerosurgical Department, The National Hospital for Neurology and Neurosurgery, London, United Kingdom

    Michael Powell

  4. Department of Neurosurgery, Madurai Medical College, Madurai, Tamil Nadu, India

    Natarajan Muthukumar

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Theodoraki, A., Vanderpump, M.P.J. (2014). Nonfunctioning Pituitary Tumour Apoplexy. In: Turgut, M., Mahapatra, A., Powell, M., Muthukumar, N. (eds) Pituitary Apoplexy. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-38508-7_4

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  • DOI: https://doi.org/10.1007/978-3-642-38508-7_4

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