Neuro-ophthalmic manifestations and outcomes of pituitary apoplexy--a life and sight-threatening emergency

Sumu Simon, David Torpy, Brian Brophy, Peter Blumbergs, Dinesh Selva, John Crompton

    Research output: Contribution to journalArticle

    11 Citations (Scopus)

    Abstract

    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.

    Original languageEnglish
    Pages (from-to)52-59
    Number of pages8
    JournalNew Zealand Medical Journal
    Volume124
    Issue number1335
    Publication statusPublished - 27 May 2011

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