Pituitary apoplexy in residual pituitary adenoma following surgical treatment in the follow-up period: management strategy

Pituitary apoplexy is a rare clinical event, used to occur spontaneously. Although, some predisposing factors for pituitary apoplexy is reported ie. head injury, digital cerebral angiography, bromocriptine therapy, coughing, lumbar puncture for CSF drainage, pneumoventriculography, even during surgery, in the immediate postoperative period and raised intracranial tension. Although pituitary apoplexy occurring following radiotherapy as primary treatment modality is reported, however, apoplexy occurring in residual adenoma following surgery, receiving adjuvant radiation therapy for residual adenoma is not reported in the literature. Authors reports two-cases of pituitary apoplexy, which occurred in the residual pituitary adenoma after a varying period in the follow-up period. These patients were previously operated by transcranial approach for decompression of the pituitary adenoma. The pituitary apoplexy occurred in one case after an interval of one and half years following surgical intervention for pituitary adenoma decompression and next case developed after five years. Both the cases had also received radiotherapy in the postoperative period for residual pituitary adenoma.