Regression of pituitary macroadenoma after intratumoral hemorrhage

Background: Pituitary apoplexy syndrome is rarely recognized, whereas it can be the first sign of a nonfunctioning adenoma. It is caused by degenerative changes of vascular origin, necrotic and/or hemorrhagic, which can involve a normal gland or a pituitary tumor. It can be found in 0.6% to 9% of all pituitary tumors. Regression of the tumor mass can occasionally occur in patients after pituitary apoplexy. Case Report: The authors present a case of pituitary macroadenoma regression as the result of hemorrhage into the tumor in a patient with clinical signs of pituitary apoplexy. Three MR examinations (at intervals of three and nine months) revealed the evolution of a hemorrhage within the tumor as well as an evident decrease in adenoma size. Because of the complete regression of clinical symptoms and hormonal inactivity of the tumor, the previously planned surgery was not performed. Results: It is important to remember the possibility of pituitary apoplexy, also in nonfunctioning adenomas. Conservative treatment should be considered when the clinical symptoms of pituitary apoplexy resolve in a patient with a nonfunctioning adenoma.