Pituitary apoplexy treated by stereotactic transphenoidal aspiration

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It is not surprising that a tumor of the pituitary, an organ so complex and important in its endocrine functions and anatomical relationship, can make its initial presence known in many different ways. Since the onset of symptoms is usually insidious and the progression slow, the tumor may have been present for a long time before it is discovered. Occasionally, the first symptom may be dramatic. There may be sudden necrosis or hemorrhage of the tumor, i.e., the syndrome of pituitary apoplexy.

Acute hemorrhagic necrosis of a pituitary adenoma was first described in a young, acromegalic patient by Bleibtreu,1 in 1905, but this syndrome was largely unrecognized until 1950 when Brougham et al2 reported the clinicopatho-logic features of five cases verified at autopsy and entitled this syndrome “pituitary apoplexy.” In 1957, Uihlein et al3 collected 72 cases and added two of their own. Since then numerous reports have been published.

This report concerns 11 cases of pituitary apoplexy seen in the Department of Neurological Surgery of the Cleveland Clinic between 1950 and 1974. The most recent case will be reported in detail to emphasize a new method of surgical treatment.

Case report

A 55-year-old white man was seen in the Department of Internal Medicine in July 1972 with a 2-year history of non-progressive fatigue and mild, nonspecific weakness of his legs. The general physical examination demonstrated findings consistent with panhypopituitarism. A neurological consultant found a slightly unsteady gait, a positive snout reflex, bilateral Babinski signs, decreased vibratory sensation in the. . .



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