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Andrioli MSD, Cukiert A, Salgado LR, Nery M, Goldman J, Knoepfelmacher M, Pimentel F, Liberman B.
Serviços de Neurocirurgia e Endocrinologia do Hospital Brigadeiro, São Paulo SP.
Pituitary apoplexy is a rare event even in macroadenomas. On the other hand, MRI findings of intratumoral necrotic areas seem to be more common than previously thought over the CT period. MRI was obtained in the last 60 cases of macroadenomas operated through the transesphenoidal route. Fifteen of them disclosed intratumoral necrotic areas on MRI. Twelve were non-secreting tumors, 2 GH-secreting and 1 prolactinoma. The clinical picture included, in addition to the secretion-related symptoms, progressive visual loss (no ictal event; n=12) and headache (n=3). Visual improvement was seen in 9 patients after surgical tumor removal and decompression of the visual pathways. Headache disappeared in 2 patients. The presence of asymptomatic areas seems to be related to the size of the tumor and not to the type or absence of endocrine secretion. This is in agreement with the potential role of relative vascular insufficiency in the pathophysiology of the genesis of these necrotic areas. Visual loss improvement after surgery is related not only to our ability to decompress the visual pathways (as in acute symptomatic pituitary apoplexy) but also to the previous optic disk degeneration caused by chronic compression.