Clinical Analysis of Hemorrhage in Pituitary Adenomas

Lee, Bong Hoon; Kim, Oh Lyong; Kim, Seung Ho; Bae, Jang Ho; Choi, Byung Yon; Cho, Soo Ho

Abstract

The authors reviewed 11 consecutive patients with hemorrhage in pituitary adenomas, which were treated by transsphenoidal approach from Jan. 1992 to Dec. 1997. We evaluated nine cases of female and 2 cases of male patients(mean age: 43.4 years old). The diagnosis of pituitary apoplexy was made by severe neurologic sign with sudden onset of headache and visual disturbance, in the setting of hemorrhage in the pituitary adenoma on computed tomographic or magnetic resonance imaging scans. Two cases were diagnosed as pituitary apoplexy and the remaining cases were diagnosed as intratumoral hemorrhages. In our series, the most common symptoms were headache(81.8%) and visual disturbance(81.8%). Other symptoms and signs were hormonal symptoms(63.6%) due to preexisting tumor, cranial nerve signs(18.2%) and alteration of mentality(18.2%). Radiologic findings were changes of sellar contour(double floor sign, widened sellae and obliteration of anterior or posterior clinoid processes) on plain skull X-ray, high density lesion in sellar area on computed tomographic scan. The magnetic resonance images were taken in all patients. Among 11 patients, 9 cases showed subacute hemorrhage(high signal intensity on T1 weighted image) and 2 showed that of chronic stage(iso signal intensity on T1 image and high signal intensity on T2 image). According to the hormonal type, the most common type of tumors associated with intratumoral hemorrhage was non-functioning adenoma(7 cases) compared to other types(GH secreting: 2, ACTH secreting: 1, Prolactin secreting: 1). All patients showed significant improvement of symptoms after surgery(average follow-up, 12.5 months). Rapid diagnosis with computed tomography and/or magnetic resonance imaging, hormonal replacement and transsphenoidal decompression constituted effective therapy.