TY - JOUR
T1 - Neuro-ophthalmic manifestations and outcomes of pituitary apoplexy--a life and sight-threatening emergency
AU - Simon, Sumu
AU - Torpy, David
AU - Brophy, Brian
AU - Blumbergs, Peter
AU - Selva, Dinesh
AU - Crompton, John
PY - 2011/5/27
Y1 - 2011/5/27
N2 - Objective To report the neuro-ophthalmic manifestations and outcomes in patients with pituitary apoplexy. Method Retrospective chart review. Results 23 patients were identified (17 men, mean age 54.1 years (range 23-86 years). The onset was abrupt in 22 patients; one patient had a subclinical presentation. Headache was the commonest presenting symptom (82.6%, 19/23). Neuro-ophthalmic manifestations were present in more than three-quarters of the patients (82.6%, 19/23). At presentation, 55 % (11/20), 47.6 % (10/21) and 60.9 % (14/23) of the patients had reduced visual acuity, field defects and cranial nerve palsies respectively. Management was conservative in 4 patients and surgical in 18 patients; one patient died shortly after presentation. The median follow up period was 10.5 months (22 patients, range 0.2-168 months). At final follow up, improvement was present in 100% of the patients with reduced acuity (8/8) and ocular palsy (13/13) and 81.8% of patients with field deficits (9/11). Age, sex, presence of precipitating factors and timing of surgery did not have an impact on neuro-ophthalmic recovery. Conclusion Pituitary apoplexy should be considered in any patient with abrupt onset of neuro-ophthalmic deficits. Prompt medical and surgical management is lifesaving and can lead to significant improvement in visual and cranial nerve deficits.
AB - Objective To report the neuro-ophthalmic manifestations and outcomes in patients with pituitary apoplexy. Method Retrospective chart review. Results 23 patients were identified (17 men, mean age 54.1 years (range 23-86 years). The onset was abrupt in 22 patients; one patient had a subclinical presentation. Headache was the commonest presenting symptom (82.6%, 19/23). Neuro-ophthalmic manifestations were present in more than three-quarters of the patients (82.6%, 19/23). At presentation, 55 % (11/20), 47.6 % (10/21) and 60.9 % (14/23) of the patients had reduced visual acuity, field defects and cranial nerve palsies respectively. Management was conservative in 4 patients and surgical in 18 patients; one patient died shortly after presentation. The median follow up period was 10.5 months (22 patients, range 0.2-168 months). At final follow up, improvement was present in 100% of the patients with reduced acuity (8/8) and ocular palsy (13/13) and 81.8% of patients with field deficits (9/11). Age, sex, presence of precipitating factors and timing of surgery did not have an impact on neuro-ophthalmic recovery. Conclusion Pituitary apoplexy should be considered in any patient with abrupt onset of neuro-ophthalmic deficits. Prompt medical and surgical management is lifesaving and can lead to significant improvement in visual and cranial nerve deficits.
UR - http://www.ncbi.nlm.nih.gov/pubmed/21946682
UR - http://www.scopus.com/inward/record.url?scp=79958015059&partnerID=8YFLogxK
M3 - Article
VL - 124
SP - 52
EP - 59
JO - New Zealand Medical Journal
JF - New Zealand Medical Journal
SN - 1175-8716
IS - 1335
ER -