[Apoplectic macroadenomas: the outcome of the residual pituitary gland].

Background and Purpose: The purpose of this retrospective study was to assess the MRI aspects and the function of the residual pituitary gland (RPG) after surgical decompression of an apoplectic pituitary macroadenoma, and to attempt to answer the question of whether an intra-adenomatous apoplexy necessarily leads to hypophyseal apoplexy.
Methods: Between 1992 and 2008, 150 pituitary macroadenomas were surgically treated via the trans-sphenoidal approach, 19 of which presented an apoplectic feature (13%). They were subdivided into three groups: pure hemorrhage, hemorrhagic infarction, and ischemic infarction. The imaging was studied after surgery to identify the RPG and establish a correlation with the endocrine status.
Results: After surgery five of 19 patients had normal adenohypophyseal function (27%), eight (42%) had panhypopituitarism, and six (31%) complete or partial corticotropic hypopituitarism. The RPG was identified on MRI in 13 patients (69%), four of them (31%) with normal adenohypophyseal function. The RPG was clearly identified intraoperatively in nine patients (47%), four of whom (44%) had normal adenohypophyseal function. One patient presented preoperative diabetes insipidus, which disappeared immediately after surgery, and two other patients developed postoperative diabetes insipidus: in one patient it quickly declined and in the other one it persisted, requiring replacement. According to the radiological classification of Hardy and Vezina modified by the Mohr (Mohr et Hardy, 1982) grade, the patients were subdivided up as follows: one grade II-0, four grade II-A, 11 grade II-B, two grade C, and one grade IV-B+D.
Conclusion: The repercussions of adenomatous apoplexy on the RPG is significant: only 27% of the patients retained normal pituitary function. Furthermore, although the RPG was identified on the MRI in more than two-thirds of the cases, more than half had adenohypophyseal failure: therefore, the visualization of a RPG does not mean that its functions are preserved. The involvement of the neurohypophysis is much rarer: one patient of 19 (5%). The implications of the ischemic or compressive damage on the normal pituitary gland are discussed.
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