[Diagnosis and treatment of subclinical pituitary apoplexy: report of 21 cases].

OBJECTIVES

To evaluate clinical manifestations of 21 patients with subclinical pituitary apoplexy and their diagnosis and treatment.

METHOD

Clinical data from 21 patients with subclinical pituitary apoplexy treated from October 1989 to November 2001 were analyzed retrospectively.

RESULTS

Their clinical manifestations included chronic headache, visual deficit and field cut. Three patients showed no clinical signs. Microsurgery was performed in 20 patients, of whom 3 were treated by emergency operation. Microsurgery included transsphenoidal decompression in 17 patients, and transpterioral approach in 3. One patient was given conservative therapy, and 12 were given endocrine replacement therapy. Nineteen patients recovered with marked visual improvement (7), partial improvement (8), no changes (4); deterioration was noted in 1.

CONCLUSIONS

Subclinical pituitary apoplexy characterized by atypical clinical manifestations may be misdiagnosed or in appropriately treated. MRI is superior to CT scan for the diagnosis of subclinical pituitary apoplexy. Patients with persistent chiasmatic syndromes are indicated for emergency surgery. Endocrine replacement and transsphnoidal decompression are effective for the improvement of severe visual disturbance.