Pituitary apoplexy epidemiology

The exact incidence of pituitary apoplexy is difficult to estimate as many cases remain undiagnosed ¹⁾.

Some series indicate that the incidence of apoplexy in pituitary adenomas is between 1% and 26% on the basis of clinical signs coupled with surgical or histopathological evidence ^{2) 3)}.

Mohr and Hardy noted typical symptomatic pituitary apoplexy to occur in only 0.6% of patients with significant hemorrhagic and necrotic changes in 9.5% of surgical specimens.

In Wilson’s series, 3% of his patients with macroadenomas had an episode of pituitary apoplexy. In another series of 560 pituitary tumors, a high incidence of 17% was found (major attack in 7%, minor in 2%, asymptomatic in 8%) ⁴⁾. It is common for apoplexy to be the initial presentation of a pituitary tumor ⁵⁾.

The very low incidence of this complication hinders formulation of widespread guidelines on diagnostic and therapeutic management ⁶⁾.

Frequency of intratumoral hemorrhage increases to 26% if using only MRI criteria without clinical evidence of apoplexy. However, hemorrhagic pituitary apoplexy may be fatal. Kurisu et al reported a 68-year-old man who developed pituitary apoplexy resulting in massive intracerebral hemorrhage and death 1 month later ⁷⁾

The male-to-female predominance is 2:1.

The age range is 37-57 years.

Male sex, non-functioning tumor, and macroadenoma are associated with an increased risk ⁸⁾.

see Covid-19 and pituitary apoplexy