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Natural history of pituitary apoplexy: a long-term follow-up study
  1. Ayesha A Shaikh,
  2. David Michael Williams,
  3. Jeffrey Wayne Stephens,
  4. Kusuma Boregowda,
  5. Maneesh Vasanth Udiawar,
  6. David E Price
  1. Endocrine and Diabetes, Morriston Hospital, Swansea, UK
  1. Correspondence to Dr Ayesha A Shaikh, Endocrine and Diabetes, Morriston Hospital, Swansea, UK; ayesha.shaikh{at}


Background and aims Pituitary apoplexy (PA) is a rare neurosurgical emergency, associated with deficiency of one or more pituitary hormones. Few studies have explored the relative outcomes associated with conservative and neurosurgical intervention.

Methods A retrospective evaluation of all patients with PA reviewed at Morriston Hospital was undertaken and diagnosis was obtained from Morriston database (Leicester Clinical Workstation database) between 1998 and 2019 from clinic letters and discharge summaries.

Results Thirty-nine patients with PA were identified with a mean age of 74.5 years and 20 (51.3%) patients were women. Patients were followed up for a mean±SD 68.1±61.7 months. Twenty-three (59.0%) patients had a known pituitary adenoma. Commoner clinical presentations of PA were ophthalmoplegia or visual field loss. Following PA, 34 (87.2%) patients were noted to have a non-functioning pituitary adenoma (either pre-existing or new), while 5 (12.8%) patients had a pre-existing functional macroadenoma. Neurosurgical intervention was taken in 15 (38.5%) patients of which 3 (20.0%) patients also received radiotherapy, 2 (13.3%) patients had radiotherapy alone and the remainder managed conservatively. External ophthalmoplegia recovered in all cases. Visual loss remained in all cases. One (2.6%) patient with chromophobe adenoma had a significant second episode of PA requiring repeat surgery.

Conclusion PA often occurs in patients with undiagnosed adenoma. Hypopituitarism commonly occurred following conservative or surgical treatment. External ophthalmoplegia resolved in all cases, however, visual loss did not recover. Pituitary tumour recurrence and further PA episodes are rare.

  • Pituitary disorders
  • Endocrine tumours

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Collaborators Not applicable.

  • Contributors AAS and DMW collected and analysed the data presented in this manuscript and drafted the article. JWS, KB and MVU supported this process, including the study design and critical review of the manuscript. DEP planned the study, obtained the data used to prepare this manuscript and is responsible for the overall content of this manuscript acting as guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.