A patient presenting with pituitary apoplexy may require surgery if certain indications are identified. The authors are from the Pituitary Apoplexy Guideline Development Group in the UK.
Patient selection: acute pituitary apoplexy
Indications for surgery:
(1) severely reduced visual acuity
(2) severe and persistent visual field defects
(3) deteriorating visual field defects
(4) deteriorating level of consciousness
(5) other severe neuro-ophthalmic signs
Isolated ocular paresis (due to involvement of CN III, IV or VI) is not an indication for surgery as it will usually resolve with conservative management.
Surgery may need to be performed immediately if the patient is rapidly deteriorating. Outcomes for visual acuity and visual field defects are better if the patient is operated on within 8 days of onset.
Surgery should be performed by an experienced pituitary surgeon if possible. If the patient is stable then transfer to a center with expertise should be considered.
where:
• An experienced pituitary surgeon performs >= 5 transsphenoidal pituitary operations per year.
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