1e:T430,SINCE Brougham et al⁶in 1950 reviewed the literature and reported five new cases of pituitary apoplexy, there has been an increasing interest in the subject. Subsequent physicians^22,26,45reporting their clinical experiences have cited other recorded cases so that the total number now stands at or near 85.^{2-11,13-15,17-26, 30-33,35-49}We have recently treated two additional patients with spontaneous hemorrhage into pituitary adenomata. The details of these are reported here.

Clinical Summaries

Case1.—A 63-year-old bricklayer was transferred from another hospital on April 29, 1960, for evaluation of headache, diplopia, drowsiness, nausea, and vomiting of five days duration. In 1954 a routine chest x-ray had shown multiple pulmonary densities which were thought to represent silicosis. However, metastatic tumor was considered, and a lateral skull film taken as part of a routine metastatic bone series showed an enlarged sella turcica. Endocrine studies showed normal 17-ketosteroid and 17-hydroxysteroid excretion values1f:T438,Pituitary apoplexy in a neuroendocrine emergency resulting from rapid enlargement of infarction of a hypophysial tumor.¹The provoking pathologic processes within the tumor may be hemorrhage, hemorrhagic infarction, or necrosis. The mortality of patients with pituitary apoplexy in various collected series is of the order of 45%,^2-4with about 15% of patients recovering spontaneously. The high mortality in this syndrome is in part related to failure of its prompt recognition, the frequently poor general status of the patients, and unnecessary delay in surgical intervention.^1,2 Although pituitary apoplexy has been more commonly reported with chromophobe adenomas, it appears to occur with disproportionate frequency in the less-common eosinophilic adenomas.⁵Taylor et al⁶in 1968 reviewed 26 cases of well-documented pituitary apoplexy occurring in acromegaly and four more patients have been described since.^7-9Study of the endocrine status of acromegalic patients surviving this catastrophe, however, has been

	Year	Citations

References