April 17, 1987

Acromegaly After Pituitary Apoplexy-Reply

Author Affiliations

Universitá di Brescia Italy

Universitá di Brescia Italy

JAMA. 1987;257(15):2034-2035. doi:10.1001/jama.1987.03390150050027

In Reply.—  We thank Dr Sadun for his favorable comments on our recent article about a case of acromegaly developing after an episode of pituitary apoplexy and strongly agree with him on the necessity of having a transnasal decompression of sellar content performed as soon as there is evidence of this ominous complication.However, this position is probably biased by the clinical experience gained in our centers, which serve as third-level referral facilities and thus care for the most severely ill patients. In fact, the spectrum of clinical presentation of pituitary apoplexy ranges from lifethreatening events to mild or even asymptomatic illnesses.1,2 This clinical heterogeneity probably depends on prior extrasellar extension of the tumor.2 As the existence of this complication becomes more widely known, more and more cases of minor apoplectic attacks are diagnosed before operation and successfully managed conservatively with careful evaluation of hormonal and metabolic status