Subarachnoid hemorrhage due to pituitary adenoma apoplexy—case report and review of the literature

• Published in: Neurological sciences Vol. 45; no. 3; pp. 997 - 1005
• Main Authors: Yildiz, Yesim, Lauber, Arno, Char, Natalia Velez, Bozinov, Oliver, Neidert, Marian Christoph, Hostettler, Isabel Charlotte
• Format: Journal Article
• Language: English
• Published: Cham Springer International Publishing 01.03.2024; Springer Nature B.V
• Subjects: Adenoma - complications; Adenoma - diagnostic imaging; Adenoma - surgery; Brain injury; Case reports; Diabetes mellitus; Female; Humans; Irritation; Literature reviews; Male; Medicine; Medicine & Public Health; Meta-analysis; Middle Aged; Neurological diseases; Neurology; Neuroradiology; Neurosurgery; Patients; Pituitary; Pituitary Apoplexy - complications; Pituitary Apoplexy - diagnostic imaging; Pituitary Apoplexy - surgery; Pituitary Neoplasms - complications; Pituitary Neoplasms - diagnostic imaging; Pituitary Neoplasms - surgery; Psychiatry; Review Article; Stroke - complications; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - diagnostic imaging; Vomiting; Pituitary apoplexy; Review; Subarachnoid hemorrhage; Outcome; Pituitary adenoma
• ISSN: 1590-1874; 1590-3478; 1590-3478
• DOI: 10.1007/s10072-023-07130-y

Pituitary apoplexy (PA) may be complicated by development of subarachnoid hemorrhage (SAH). We conducted a literature review to evaluate the rate of PA-associated tumor rupture and SAH. We conducted a systematic literature search (PubMed, Web of Science, Medline) for patients with PA-associated SAH and report a case SAH following PA. Suitable articles, case series, and case reports were selected based on predefined criteria following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). We reviewed included publications for clinical, radiological, surgical, and histopathological parameters.We present the case of a patient with PA developing extensive SAH whilst on the MRI who underwent delayed transsphenoidal resection. According to our literature review, we found 55 patients with a median age of 46 years; 18 (32.7%) were female. Factors associated with PA-related SAH were hypertension, diabetes mellitus, prior trauma, anticoagulant, and/or antiplatelet therapy. The most common presenting symptoms included severe headache, nausea and/or vomiting, impaired consciousness, and meningeal irritation. Acute onset was described in almost all patients. Twenty-two of the included patients underwent resection. In patients with available outcome, 45.1% had a favorable outcome, 10 (19.6%) had persisting focal neurological deficits, 7 developed cerebral vasospasms (12.7%), and 18 (35.3%) died. Mortality greatly differed between surgically (9.1%) and non-surgically (44.8%) treated patients. PA-associated SAH is a rare condition developing predominantly in males with previously unknown macroadenomas. Timely surgery often prevents aggravation or development of severe neuro-ophthalmological defects and improves clinical outcome.