• Lora Stanka Kirigin Biloš, Ivan Kruljac, Jelena Marinković Radošević, Miroslav Ćaćić, Ivan Škoro, Vatroslav Čerina, Ivan Hrvoje Pećina, and Milan Vrkljan.
• Department of Endocrinology, Diabetology and Metabolic Diseases "Mladen Sekso", University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia. Electronic address: lora.s.kirigin@gmail.com.
• World Neurosurg. 2019 Aug 1; 128: 366-370.

BackgroundPituitary apoplexy may occur when a large tumor compresses or outgrows its nutrient supply, resulting in ischemic necrosis and hemorrhage. Although once deemed a neurosurgical emergency, increasing evidence suggests that conservative management of pituitary apoplexy leads to favorable neuro-ophthalmologic and endocrinologic outcomes as well. Spontaneous remission after pituitary apoplexy has been described in functioning pituitary adenomas, but it is a rare occurrence in nonfunctioning tumors.Case DescriptionWe report a man that presented with pituitary apoplexy of a nonfunctioning pituitary macroadenoma that was managed conservatively and treated hormonally for hypopituitarism during a 2-year follow-up period, with serial neuroimaging demonstrating significant tumor volume reduction with almost complete resolution resulting in partial empty sella. In addition, a short literature review was performed pertaining to the management of pituitary apoplexy with emphasis on a more conservative approach.ConclusionsA subset of patients with pituitary apoplexy without altered consciousness and nonprogressive or mild ophthalmologic deficits may be managed conservatively; however, lifelong periodic assessment, preferably by a specialized multidisciplinary pituitary team, is essential until clinical outcomes become clear.Copyright © 2019 Elsevier Inc. All rights reserved.

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