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).

Wakai S, Fukushima T, Teramoto A, Sano K. Pituitary apoplexy: its incidence and clinical significance. J Neurosurg. 1981 Aug;55(2):187-93. doi: 10.3171/jns.1981.55.2.0187. PMID: 7252541.
Mohr G, Hardy J. Hemorrhage, necrosis, and apoplexy in pituitary adenomas. Surg Neurol. 1982 Sep;18(3):181-9. doi: 10.1016/0090-3019(82)90388-3. PMID: 7179072.
Mohanty S, Tandon PN, Banerji AK, Prakash B. Haemorrhage into pituitary adenomas. J Neurol Neurosurg Psychiatry. 1977 Oct;40(10):987-91. doi: 10.1136/jnnp.40.10.987. PMID: 591978; PMCID: PMC492882.
Wakai S, Fukushima T, Teramoto A, Sano K. Pituitary Apoplexy: Its Incidence and Clinical Signifi- cance. J Neurosurg. 1981; 55:187–193
Rovit RL, Fein JM. Pituitary Apoplexy, A Review and Reappraisal. J Neurosurg. 1972; 37:280–288
Witek P. Pituitary apoplexy: managing the life-threatening condition associated with pituitary adenomas. Minerva Endocrinol. 2014 Dec;39(4):245-59. Epub 2014 Jul 29. Review. PubMed PMID: 25069845.
Kurisu K, Kawabori M, Niiya Y, Ohta Y, Mabuchi S, Houkin K. Pituitary apoplexy manifesting as massive intracerebral hemorrhage. Case report. Neurol Med Chir (Tokyo). 2012. 52(8):587-90.
Zhu X, Wang Y, Zhao X, Jiang C, Zhang Q, Jiang W, Wang Y, Chen H, Shou X, Zhao Y, Li Y, Li S, Ye H. Incidence of Pituitary Apoplexy and Its Risk Factors in Chinese People: A Database Study of Patients with Pituitary Adenoma. PLoS One. 2015 Sep 25;10(9):e0139088. doi: 10.1371/journal.pone.0139088. eCollection 2015. PubMed PMID: 26407083; PubMed Central PMCID: PMC4583273.
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