FP21-1 Sellar Hematoma Following Transsphenoidal Pituitary Surgery (TSS) Causing Acute Hypopituitarism: Clinical and Biochemical Characteristics

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: FP21-HPA Axis: New Clinical Developments
Clinical
Sunday, June 16, 2013: 10:45 AM-11:15 AM
Presentation Start Time: 10:45 AM
Room 134 (Moscone Center)

Poster Board SUN-50
Katia El Sibai*1, Pratibha P Raghavendra2, Warren Selman2 and Baha M Arafah3
1University Hospitals Case Medical Center, Cleveland, OH, 2University Hospitals, Case Medical Center, Cleveland, OH, 3Case Western Reserve Univ, Cleveland, OH
Background/Objectives: Postoperative hematoma can develop following TSS as a result of oozing at the surgical site. Although it is often mild and clinically unrecognized, it can at times be large enough to create a mass effect on the normal pituitary that might impair its function. The impact of a large hematoma on pituitary function is not well appreciated. The goals of this study are to review clinical and biochemical characteristics of this complication.

Methods: Records of consecutive patients who had TSS for removal of large pituitary masses [adenomas (PA) n=188 or Rathke’s Cleft Cyst (RCC) n=77] were reviewed for documentation of postoperative clinical course, biochemical and imaging studies of sellar hematoma. In all patients, pituitary function was closely monitored in the perioperative period without glucocorticoid administration.

Results: 14/265 patients who underwent TSS (10/188 with PA and 4/77 with RCC; p=0.96) had clinical and imaging documentation of postoperative hematoma 3.5± 2.7 days after surgery. Age and gender of patients who had hematomas were similar to those who did not. 4/14 who had hematomas were taking aspirin that was discontinued over a week preoperatively. Clinical suspicion for the diagnosis included: fatigue (10/14), headache (7/14) and visual symptoms (4/14). Biochemical features included rapid decline in ACTH, cortisol and DHEA levels (p<0.01) such that AM cortisol levels were low (<5 ug/dL) in 12/14 and hyponatremia was present in 5/14 patients at diagnosis. There were no acute changes in serum prolactin levels. Glucocorticoids were administered to patients for 1-3 weeks with gradual resolution of symptoms while surgical re-exploration was necessary in 2. Recovery of HPA function was documented in 11/12 who had impaired axis at diagnosis. No changes/worsening in pituitary function were noted in any of the remaining 251 patients who had no symptoms suspicious of hematoma.

Summary and conclusions: The development of postoperative sellar hematoma when large can result in a transient mass effect that causes headaches, visual symptoms and acute hypopituitarism primarily manifested by impaired HPA function. Prompt recognition and glucocorticoid administration lead to resolution of clinical manifestations and recovery of pituitary function. The rapid onset and reversibility of hypopituitarism suggest that compression of portal vessels/pituitary stalk by the hematoma was the primary mechanism of pituitary dysfunction.

Nothing to Disclose: KE, PPR, WS, BMA

*Please take note of The Endocrine Society's News Embargo Policy at http://www.endo-society.org/endo2013/media.cfm

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