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April 17, 1987

Acromegaly After Pituitary Apoplexy

Author Affiliations

University of Southern California School of Medicine Los Angeles

University of Southern California School of Medicine Los Angeles

JAMA. 1987;257(15):2034. doi:10.1001/jama.1987.03390150050026

To the Editor.—  I enjoyed reading Candrina and Giustina's1 article in the Dec 5, 1986, issue of JAMA on pituitary apoplexy. As the authors correctly point out, pituitary apoplexy is a neurosurgical emergency that needs to be dealt with promptly. Immediate surgical decompression may prevent the further destruction of the contents of the nearby cavernous sinus and possibly irreversible damage to the overlying optic chiasm. Failure to perform prompt decompression may lead to serious morbidity and even mortality.2,3It is for this reason that I wanted to address several atypical aspects of their case and of their management of it. Their patient presented with headache and projectile vomiting. No mention is made of any cranial nerve palsy. More commonly, patients with pituitary apoplexy complain of extremely severe headache and either diplopia (due to cavernous sinus syndrome) or visual loss (which may be unilateral or bilateral).Candrina and Giustina's