Hemorrhagic pituitary adenomas: Clinicopathological features and surgical treatment

B. Fraioli, V. Esposito, L. Palma, G. Cantore

Research output: Contribution to journalArticle

Abstract

Firty-five (9.9%) of 453 pituitary adenomas operated on between January 1973 and November 1988 demonstrated hemorrhagic changes at surgery: 24 had a blood collection, 12 had a blood collection associated with hemorrhagic necrosis, and 9 had hemorrhagic necrosis. Thirteen patients (28.9%) experienced the acute symptoms of pituitary apoplexy, whereas another 32 had an 'asymptomatic' hemorrhage, that is, the clinical course was comparable to an uncomplicated adenoma. Nineteen tumors (42.2%) showed marked suprasellar extension, 8 (17.8%) showed moderate extension, and 11 (24.5%) showed slight extension; another 2 (4.4%) were laterosellar and 5 (11.1%) were intrasellar. Invasive behavior was present in 32 cases (71.1%) and this may suggest another hypothesis to explain the pathogenesis of tumoral hemorrhage. The incidence of hemorrhagic complications in invasive adenomas with marked suprasellar extension was particularly impressive; therefore, we do not suggest preoperative bromocriptine treatment in this type of tumor. Two of 14 patients operated on by the transcranial route died after surgery, whereas there was no operative mortality in the 31 patients operated on by the transsphenoidal route. It proved advantageous to operate as early as possible, even during the acute phase of pituitary apoplexy. The transsphenoidal approach gave the best results, but to achieve satisfactory late results multidisciplinary treatment was necessary, namely, postoperative radiotherapy in 23 patients, bromocriptine in 12, and endocrine replacement therapy in almost all. In an average follow-up period of 6.2 years, 5 (11.1%) symptomatic recurrences were observed.

Original languageEnglish
Pages (from-to)741-748
Number of pages8
JournalNeurosurgery
Volume27
Issue number5
Publication statusPublished - 1990

Fingerprint

Pituitary Neoplasms
Pituitary Apoplexy
Bromocriptine
Adenoma
Necrosis
Hemorrhage
Therapeutics
Neoplasms
Radiotherapy
Recurrence
Mortality
Incidence

Keywords

  • Hemorrhagic adenoma
  • Invasive adenoma
  • Pituitary adenoma
  • Pituitary apoplexy
  • Transsphenoidal surgery

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Hemorrhagic pituitary adenomas : Clinicopathological features and surgical treatment. / Fraioli, B.; Esposito, V.; Palma, L.; Cantore, G.

In: Neurosurgery, Vol. 27, No. 5, 1990, p. 741-748.

Research output: Contribution to journalArticle

Fraioli, B, Esposito, V, Palma, L & Cantore, G 1990, 'Hemorrhagic pituitary adenomas: Clinicopathological features and surgical treatment', Neurosurgery, vol. 27, no. 5, pp. 741-748.
Fraioli, B. ; Esposito, V. ; Palma, L. ; Cantore, G. / Hemorrhagic pituitary adenomas : Clinicopathological features and surgical treatment. In: Neurosurgery. 1990 ; Vol. 27, No. 5. pp. 741-748.
@article{2fc71d12ac7e43d881c71ab7c1033936,
title = "Hemorrhagic pituitary adenomas: Clinicopathological features and surgical treatment",
abstract = "Firty-five (9.9{\%}) of 453 pituitary adenomas operated on between January 1973 and November 1988 demonstrated hemorrhagic changes at surgery: 24 had a blood collection, 12 had a blood collection associated with hemorrhagic necrosis, and 9 had hemorrhagic necrosis. Thirteen patients (28.9{\%}) experienced the acute symptoms of pituitary apoplexy, whereas another 32 had an 'asymptomatic' hemorrhage, that is, the clinical course was comparable to an uncomplicated adenoma. Nineteen tumors (42.2{\%}) showed marked suprasellar extension, 8 (17.8{\%}) showed moderate extension, and 11 (24.5{\%}) showed slight extension; another 2 (4.4{\%}) were laterosellar and 5 (11.1{\%}) were intrasellar. Invasive behavior was present in 32 cases (71.1{\%}) and this may suggest another hypothesis to explain the pathogenesis of tumoral hemorrhage. The incidence of hemorrhagic complications in invasive adenomas with marked suprasellar extension was particularly impressive; therefore, we do not suggest preoperative bromocriptine treatment in this type of tumor. Two of 14 patients operated on by the transcranial route died after surgery, whereas there was no operative mortality in the 31 patients operated on by the transsphenoidal route. It proved advantageous to operate as early as possible, even during the acute phase of pituitary apoplexy. The transsphenoidal approach gave the best results, but to achieve satisfactory late results multidisciplinary treatment was necessary, namely, postoperative radiotherapy in 23 patients, bromocriptine in 12, and endocrine replacement therapy in almost all. In an average follow-up period of 6.2 years, 5 (11.1{\%}) symptomatic recurrences were observed.",
keywords = "Hemorrhagic adenoma, Invasive adenoma, Pituitary adenoma, Pituitary apoplexy, Transsphenoidal surgery",
author = "B. Fraioli and V. Esposito and L. Palma and G. Cantore",
year = "1990",
language = "English",
volume = "27",
pages = "741--748",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "5",

}

TY - JOUR

T1 - Hemorrhagic pituitary adenomas

T2 - Clinicopathological features and surgical treatment

AU - Fraioli, B.

AU - Esposito, V.

AU - Palma, L.

AU - Cantore, G.

PY - 1990

Y1 - 1990

N2 - Firty-five (9.9%) of 453 pituitary adenomas operated on between January 1973 and November 1988 demonstrated hemorrhagic changes at surgery: 24 had a blood collection, 12 had a blood collection associated with hemorrhagic necrosis, and 9 had hemorrhagic necrosis. Thirteen patients (28.9%) experienced the acute symptoms of pituitary apoplexy, whereas another 32 had an 'asymptomatic' hemorrhage, that is, the clinical course was comparable to an uncomplicated adenoma. Nineteen tumors (42.2%) showed marked suprasellar extension, 8 (17.8%) showed moderate extension, and 11 (24.5%) showed slight extension; another 2 (4.4%) were laterosellar and 5 (11.1%) were intrasellar. Invasive behavior was present in 32 cases (71.1%) and this may suggest another hypothesis to explain the pathogenesis of tumoral hemorrhage. The incidence of hemorrhagic complications in invasive adenomas with marked suprasellar extension was particularly impressive; therefore, we do not suggest preoperative bromocriptine treatment in this type of tumor. Two of 14 patients operated on by the transcranial route died after surgery, whereas there was no operative mortality in the 31 patients operated on by the transsphenoidal route. It proved advantageous to operate as early as possible, even during the acute phase of pituitary apoplexy. The transsphenoidal approach gave the best results, but to achieve satisfactory late results multidisciplinary treatment was necessary, namely, postoperative radiotherapy in 23 patients, bromocriptine in 12, and endocrine replacement therapy in almost all. In an average follow-up period of 6.2 years, 5 (11.1%) symptomatic recurrences were observed.

AB - Firty-five (9.9%) of 453 pituitary adenomas operated on between January 1973 and November 1988 demonstrated hemorrhagic changes at surgery: 24 had a blood collection, 12 had a blood collection associated with hemorrhagic necrosis, and 9 had hemorrhagic necrosis. Thirteen patients (28.9%) experienced the acute symptoms of pituitary apoplexy, whereas another 32 had an 'asymptomatic' hemorrhage, that is, the clinical course was comparable to an uncomplicated adenoma. Nineteen tumors (42.2%) showed marked suprasellar extension, 8 (17.8%) showed moderate extension, and 11 (24.5%) showed slight extension; another 2 (4.4%) were laterosellar and 5 (11.1%) were intrasellar. Invasive behavior was present in 32 cases (71.1%) and this may suggest another hypothesis to explain the pathogenesis of tumoral hemorrhage. The incidence of hemorrhagic complications in invasive adenomas with marked suprasellar extension was particularly impressive; therefore, we do not suggest preoperative bromocriptine treatment in this type of tumor. Two of 14 patients operated on by the transcranial route died after surgery, whereas there was no operative mortality in the 31 patients operated on by the transsphenoidal route. It proved advantageous to operate as early as possible, even during the acute phase of pituitary apoplexy. The transsphenoidal approach gave the best results, but to achieve satisfactory late results multidisciplinary treatment was necessary, namely, postoperative radiotherapy in 23 patients, bromocriptine in 12, and endocrine replacement therapy in almost all. In an average follow-up period of 6.2 years, 5 (11.1%) symptomatic recurrences were observed.

KW - Hemorrhagic adenoma

KW - Invasive adenoma

KW - Pituitary adenoma

KW - Pituitary apoplexy

KW - Transsphenoidal surgery

UR - http://www.scopus.com/inward/record.url?scp=0025175326&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0025175326&partnerID=8YFLogxK

M3 - Article

C2 - 2259404

AN - SCOPUS:0025175326

VL - 27

SP - 741

EP - 748

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

IS - 5

ER -