neurosurgeryНейрохирургияRussian journal of neurosurgery1683-32952587-7569Издательский дом "МедИНК"10.63769/1683-3295-2026-28-1-20-32neurosurgery-1812Research ArticleОРИГИНАЛЬНАЯ РАБОТАORIGINAL REPORTКровоизлияние в опухоль гипофиза – срочная операция или выжидательная тактика?Pituitary apoplexy – an urgent operation or a wait-and-see strategy?https://orcid.org/0000-0002-6520-4296КутинМ. А.KutinM. A.

М.А. Кутин

125047 Москва, ул. 4‑я Тверская-Ямская, 16

M.A. Kutin

16 Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0001-8344-3381КадашевБ. А.KadashevB. A.

Б.А. Кадашев

125047 Москва, ул. 4‑я Тверская-Ямская, 16

B.A. Kadashev

16 Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0003-4480-1902АстафьеваЛ. И.AstafyevaL. I.

Л.И. Астафьева

125047 Москва, ул. 4‑я Тверская-Ямская, 16

L.I. Astafyeva

16 Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0003-3445-3115ШкарубоА. Н.ShkaruboA. N.

А.Н. Шкарубо

125047 Москва, ул. 4‑я Тверская-Ямская, 16

A.N. Shkarubo

16 Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0002-5323-1000ФомичевД. В.FomichevD. V.

Д.В. Фомичев

125047 Москва, ул. 4‑я Тверская-Ямская, 16

D.V. Fomichev

16 Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0003-3777-5662ШариповО. И.SharipovO. I.

О.И. Шарипов

125047 Москва, ул. 4‑я Тверская-Ямская, 16

O.I. Sharipov

16 Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0002-9789-3452ЧерновИ. В.ChernovI. V.

И.В. Чернов

125047 Москва, ул. 4‑я Тверская-Ямская, 16

I.V. Chernov

16 Tverskaya-Yamskaya St., Moscow 125047

ichernov@nsi.ruhttps://orcid.org/0000-0002-5619-0152УраковС. В.UrakovS. V.

С.В. Ураков

125047 Москва, ул. 4‑я Тверская-Ямская, 16

S.V. Urakov

16 Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0003-2317-8410ВоронинаИ. А.VoroninaI. A.

И.А. Воронина

125047 Москва, ул. 4‑я Тверская-Ямская, 16

I.A. Voronina

16 Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0003-0148-7298СероваН. К.SerovaN. K.

Н.К. Серова

125047 Москва, ул. 4‑я Тверская-Ямская, 16

N.K. Serova

16 Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0003-3199-1452ТропинскаяО. Ф.TropinskayaO. F.

О.Ф. Тропинская

125047 Москва, ул. 4‑я Тверская-Ямская, 16

O.F. Tropinskaya

16 Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0003-2733-5874СидневаЮ. Г.SidnevaYu. G.

Ю. Г. Сиднева

125047 Москва, ул. 4‑я Тверская-Ямская, 16

Ju.G. Sidneva

16 Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0001-7045-7223ШишкинаЛ. В.ShishkinaL. V.

Л.В. Шишкина

125047 Москва, ул. 4‑я Тверская-Ямская, 16

L.V. Shishkina

16 Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0002-9010-3059ТуркинА. М.TurkinA. M.

А.М. Туркин

125047 Москва, ул. 4‑я Тверская-Ямская, 16

A.M. Turkin

16 Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0002-0719-5168ДонскойА. Д.DonskoyA. D.

А.Д. Донской

125047 Москва, ул. 4‑я Тверская-Ямская, 16

A.D. Donskoy

16 Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0002-7440-4687КлочковаИ. С.KlochkovaI. S.

И.С. Клочкова

125047 Москва, ул. 4‑я Тверская-Ямская, 16

I.S. Klochkova

16 Tverskaya-Yamskaya St., Moscow 125047

https://orcid.org/0000-0001-9333-9473КалининП. Л.KalininP. L.

П.Л. Калинин

125047 Москва, ул. 4‑я Тверская-Ямская, 16

P.L. Kalinin

16 Tverskaya-Yamskaya St., Moscow 125047

ФГАУ «Национальный медицинский исследовательский центр нейрохирургии им. акад. Н. Н. Бурденко» Минздрава РоссииРоссияN. N. Burdenko National Medical Research Center of Neurosurgery, Ministry of Health of RussiaRussian Federation2026140420262812032Copyright © Кутин М.А., Кадашев Б.А., Астафьева Л.И., Шкарубо А.Н., Фомичев Д.В., Шарипов О.И., Чернов И.В., Ураков С.В., Воронина И.А., Серова Н.К., Тропинская О.Ф., Сиднева Ю.Г., Шишкина Л.В., Туркин А.М., Донской А.Д., Клочкова И.С., Калинин П.Л., 20262026Кутин М.А., Кадашев Б.А., Астафьева Л.И., Шкарубо А.Н., Фомичев Д.В., Шарипов О.И., Чернов И.В., Ураков С.В., Воронина И.А., Серова Н.К., Тропинская О.Ф., Сиднева Ю.Г., Шишкина Л.В., Туркин А.М., Донской А.Д., Клочкова И.С., Калинин П.Л.Kutin M.A., Kadashev B.A., Astafyeva L.I., Shkarubo A.N., Fomichev D.V., Sharipov O.I., Chernov I.V., Urakov S.V., Voronina I.A., Serova N.K., Tropinskaya O.F., Sidneva Y.G., Shishkina L.V., Turkin A.M., Donskoy A.D., Klochkova I.S., Kalinin P.L.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.therjn.com/jour/article/view/1812Введение

Введение. Опухоли гипофиза относятся к часто встречающейся патологии в нейроонкологии. Достигая 10 % среди интракраниальных опухолей, длительное время могут не иметь клинических проявлений. В ситуациях, когда питуитарная апоплексия (ПА) оказывается первым проявлением заболевания, выбор оптимальной тактики особенно актуален. Учитывая наличие наблюдений спонтанной резорбции опухоли после ПА, стандартный подход к данной патологии как к исключительной ургентной требует пересмотра.

Цель исследования – пересмотреть стратегию лечения пациентов с ПА, определив факторы, способствующие как резорбции опухоли, так и достижению лучшего клинического результата; уточнив показания к операции, создать алгоритм лечения пациента с ПА.

Материалы и методы

Материалы и методы. В работе проанализированы результаты лечения 82 пациентов с ПА. Только 45 пациентов были прооперированы. У 37 пациентов по мере подготовки к операции потребность в ней отпала.

Результаты

Результаты. В результате анализа результатов лечения 82 пациентов с ПА выявлены оптимальные параметры опухоли и ее рентгенологические характеристики, при которых вероятность спонтанной резорбции наивысшая – 89,2 % (33 из 37) случаев. Опыт применения дексаметазона в структуре терапии показал его ключевую роль в достижении оптимального результата. Анализ материала позволил сформулировать критерии, при которых выжидательная тактика при ПА может обеспечить результат, как минимум сопоставимый с хирургическим методом лечения, а в отношении сохранения гипофизарных функций даже превосходящий его.

Заключение

Заключение. В результате проведенного исследования предложен алгоритм лечения пациентов с ПА. Применение предложенного алгоритма позволит в ряде случаев, отказавшись от экстренной операции, получить сопоставимый клинический результат с меньшим риском для пациента.

Background

Background. Pituitary tumors are a common pathology in neuro-oncology. They constitute 10 % of all intracranial tumors; and for a long time, they may not have any clinical manifestations. In situations where pituitary apoplexy is the first manifestation of the disease, the choice of optimal tactics is particularly relevant. Considering cases of spontaneous tumor resorption after pituitary apoplexy, the standard approach to this pathology as an exceptional urgent one requires revision.

Aim

Aim. To review the treatment strategy of patients with pituitary apoplexy, identifying factors contributing to both tumor resorption and achievement of a better clinical result. After specification of the indications for surgery, to create an algorithm for treating patients with pituitary apoplexy.

Materials and methods

Materials and methods. The paper analyzes the results of treatment of 82 patients with pituitary apoplexy. Only 45 patients were operated on. In 37 patients, the need for surgery ceased during preparation.

Results

Results. Analysis of treatment results of 82 patients with pituitary apoplexy identified optimal tumor parameters and radiological characteristics for which the probability of spontaneous resorption is the highest: 89.2 % (33 out of 37) cases. The use of dexamethasone as part of therapy has shown to play a key role in achieving optimal results. The analysis of the data allowed us to formulate criteria for which a wait-and-see tactic in pituitary apoplexy can provide a result comparable to the surgical method of treatment and even surpassing it in terms of preservation of pituitary functions.

Conclusion

Conclusion. As a result of the study, an algorithm for treatment of patients with pituitary apoplexy was proposed. The application of the proposed algorithm will allow, in some cases, to forego an emergency surgery and obtain a comparable clinical result with less risk for the patient.

аденома гипофизакровоизлияниеэндоскопическая трансназальная хирургияpituitary adenomahemorrhageendoscopic transnasal surgeryReferencesEzzat S., Asa S.L., Couldwell W.T. et al. The prevalence of pituitary adenomas: a systematic review. Cancer 2004;101(3):613–9. DOI: 10.1002/cncr.20412Ezzat S., Asa S.L., Couldwell W.T. et al. The prevalence of pituitary adenomas: a systematic review. Cancer 2004;101(3):613–9. DOI: 10.1002/cncr.20412Fernandez A., Karavitaki N., Wass J.A. Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol 2010;72(3):377–82. DOI: 10.1111/j.1365-2265.2009.03667.xFernandez A., Karavitaki N., Wass J.A. Prevalence of pituitary adenomas: a community-based, cross-sectional study in Banbury (Oxfordshire, UK). Clin Endocrinol 2010;72(3):377–82. DOI: 10.1111/j.1365-2265.2009.03667.xIto Y., Takano S., Muroi A., Matsumura A. Massive subarachnoid hemorrhage and intraventricular hemorrhage after transsphenoidal surgery of pituitary adenoma: a case report. No shinkei geka 2009;37(9):887–92. (In Japanese).Ito Y., Takano S., Muroi A., Matsumura A. Massive subarachnoid hemorrhage and intraventricular hemorrhage after transsphenoidal surgery of pituitary adenoma: a case report. No shinkei geka 2009;37(9):887–92. (In Japanese).Serhal D., Weil R.J., Hamrahian A.H. Evaluation and management of pituitary incidentalomas. Cleveland Clin J Med 2008;75(11):793–801.Serhal D., Weil R.J., Hamrahian A.H. Evaluation and management of pituitary incidentalomas. Cleveland Clin J Med 2008;75(11):793–801.Salehi F., Kovacs K., Cusimano M.D. et al. Immunohistochemical expression of nestin in adenohypophysial vessels during development of pituitary infarction. J Neurosur 2008;108(1):118–23. DOI: 10.3171/jns/2008/108/01/0118Salehi F., Kovacs K., Cusimano M.D. et al. Immunohistochemical expression of nestin in adenohypophysial vessels during development of pituitary infarction. J Neurosur 2008;108(1):118–23. DOI: 10.3171/jns/2008/108/01/0118Kim S.H., Lee K.C. Cranial nerve palsies accompanying pituitary tumour. J Clin Neurosci 2007;14(12):1158–62. DOI: 10.1016/j.jocn.2006.07.016Kim S.H., Lee K.C. Cranial nerve palsies accompanying pituitary tumour. J Clin Neurosci 2007;14(12):1158–62. DOI: 10.1016/j.jocn.2006.07.016Huang D.Q., Li W.R., Ou X.Y. Transsphenoidal endoscopic management of pituitary apoplexy sphenoid mucocele. Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese Journal of Otorhinolaryngology Head and Neck Surgery 2006;41(4):306–7.Huang D.Q., Li W.R., Ou X.Y. Transsphenoidal endoscopic management of pituitary apoplexy sphenoid mucocele. Zhonghua er bi yan hou tou jing wai ke za zhi = Chinese Journal of Otorhinolaryngology Head and Neck Surgery 2006;41(4):306–7.Sibal L., Ball S.G., Connolly V. et al. Pituitary apoplexy: a review of clinical presentation, management and outcome in 45 cases. Pituitary 2004;7(3):157–63. DOI: 10.1007/s11102-005-1050-3Sibal L., Ball S.G., Connolly V. et al. Pituitary apoplexy: a review of clinical presentation, management and outcome in 45 cases. Pituitary 2004;7(3):157–63. DOI: 10.1007/s11102-005-1050-3Semple P.L., Jane J.A. Jr., Laws E.R. Jr. Clinical relevance of precipitating factors in pituitary apoplexy. Neurosurgery 2007;61(5):956–61; discussion 961–952. DOI: 10.1227/01.neu.0000303191.57178.2aSemple P.L., Jane J.A. Jr., Laws E.R. Jr. Clinical relevance of precipitating factors in pituitary apoplexy. Neurosurgery 2007;61(5):956–61; discussion 961–952. DOI: 10.1227/01.neu.0000303191.57178.2aCarsote M., Chirita C., Dumitrascu A. et al. Pituitary incidentalomas – how often is too often? J Med Life 2009;2(1):92–7.Carsote M., Chirita C., Dumitrascu A. et al. Pituitary incidentalomas – how often is too often? J Med Life 2009;2(1):92–7.Xing B., Deng K., Ren Z.Y. et al. Magnetic resonance imaging characteristics and surgical results of adrenocorticotropin-secreting pituitary adenomas. Chinese Medical Sciences journal = Chungkuo i hsueh k’o hsueh tsa chih / Chinese Academy of Medical Sciences 2008;23(1):44–8.Xing B., Deng K., Ren Z.Y. et al. Magnetic resonance imaging characteristics and surgical results of adrenocorticotropin-secreting pituitary adenomas. Chinese Medical Sciences journal = Chungkuo i hsueh k’o hsueh tsa chih / Chinese Academy of Medical Sciences 2008;23(1):44–8.Hiroi N., Ichijo T., Shimojo M. et al. Pituitary apoplexy caused by luteinizing hormone-releasing hormone in prolactin-producing adenoma. Int Med (Tokyo, Japan) 2001;40(8):747–50.Hiroi N., Ichijo T., Shimojo M. et al. Pituitary apoplexy caused by luteinizing hormone-releasing hormone in prolactin-producing adenoma. Int Med (Tokyo, Japan) 2001;40(8):747–50.Haboubi H., Azam I., Edavalath M. et al. Apoplexy in a corticotrophin-secreting pituitary macroadenoma: a case report and review of the literature. QJM: Monthly Journal of the Association of Physicians 2010;103(8):607–9. DOI: 10.1093/qjmed/hcp197Haboubi H., Azam I., Edavalath M. et al. Apoplexy in a corticotrophin-secreting pituitary macroadenoma: a case report and review of the literature. QJM: Monthly Journal of the Association of Physicians 2010;103(8):607–9. DOI: 10.1093/qjmed/hcp197Matti A.I., Rudkin A.K., Lee A.W., Chen C.S. Isolated unilateral abducens cranial nerve palsy: a rare presentation of pituitary apoplexy. Eur J Ophthalmol 2010;20(1):234–6.Matti A.I., Rudkin A.K., Lee A.W., Chen C.S. Isolated unilateral abducens cranial nerve palsy: a rare presentation of pituitary apoplexy. Eur J Ophthalmol 2010;20(1):234–6.Shou X.F., Wang Y.F., Li S.Q. et al. Microsurgical treatment for typical pituitary apoplexy with 44 patients, according to two pathological stages. Minimally Invasive Neurosurgery: MIn 2009;52(5–6):207–11. DOI: 10.1055/s-0029-1241848Shou X.F., Wang Y.F., Li S.Q. et al. Microsurgical treatment for typical pituitary apoplexy with 44 patients, according to two pathological stages. Minimally Invasive Neurosurgery: MIn 2009;52(5–6):207–11. DOI: 10.1055/s-0029-1241848Baglin G., Betermiez P., Bertout A. et al. [Pituitary apoplexy and severe bilateral visual loss: a case report]. Journal francais d’ophtalmologie 2009;32(8):572–6. (In French). DOI: 10.1016/j.jfo.2009.04.019Baglin G., Betermiez P., Bertout A. et al. [Pituitary apoplexy and severe bilateral visual loss: a case report]. Journal francais d’ophtalmologie 2009;32(8):572–6. (In French). DOI: 10.1016/j.jfo.2009.04.019Eaton H.J., Phillips P.J., Hanieh A. et al. Rapid onset of pituitary apoplexy after goserelin implant for prostate cancer: need for heightened awareness. Int Med J 2001;31(5):313–4.Eaton H.J., Phillips P.J., Hanieh A. et al. Rapid onset of pituitary apoplexy after goserelin implant for prostate cancer: need for heightened awareness. Int Med J 2001;31(5):313–4.De Heide L.J., van Tol K.M., Doorenbos B. Pituitary apoplexy presenting during pregnancy. Net J Med 2004;62(10):393–6.De Heide L.J., van Tol K.M., Doorenbos B. Pituitary apoplexy presenting during pregnancy. Net J Med 2004;62(10):393–6.Калинин П.Л., Фомичев Д.В., Кутин М.А. Наш опыт освоения современной эндоскопической трансназальной хирургии патологии хиазмально-селлярной области. Вестник неврологии, психиатрии и нейрохирургии 2017;(12):22–4Kalinin P.L., Fomichev D.V., Kutin M.A. Our experience in the development of modern endoscopic transnasal surgery of the pathology of the chiasmatic-selar region. Vestnik nevrologii, psikhiatrii i neirokhirurgii = Bulletin of Neurology, Psychiatry and Neurosurgery 2017;(12):22–4. (In Russ.).Vanderpump M., Higgens C., Wass J.A. UK guidelines for the management of pituitary apoplexy a rare but potentially fatal medical emergency. Emergency Medicine Journal: EMJ 2011;28(7):550–1. DOI: 10.1136/emj.2010.106898Vanderpump M., Higgens C., Wass J.A. UK guidelines for the management of pituitary apoplexy a rare but potentially fatal medical emergency. Emergency Medicine Journal: EMJ 2011;28(7):550–1. DOI: 10.1136/emj.2010.106898Kasai K., Suzuki H., Nakamura T. et al. A case of pituitary apoplexy with spontaneous recovery. Endocrinologia Japonica 1978;25(3):209–16.Kasai K., Suzuki H., Nakamura T. et al. A case of pituitary apoplexy with spontaneous recovery. Endocrinologia Japonica 1978;25(3):209–16.Zielinski G., Witek P., Koziarski A., Podgorski J. Spontaneous regression of non-functioning pituitary adenoma due to pituitary apoplexy following anticoagulation treatment – a case report and review of the literature. Endokrynol Pol 2013;64(1):54–8.Zielinski G., Witek P., Koziarski A., Podgorski J. Spontaneous regression of non-functioning pituitary adenoma due to pituitary apoplexy following anticoagulation treatment – a case report and review of the literature. Endokrynol Pol 2013;64(1):54–8.Randeva H.S., Schoebel J., Byrne J. et al. Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol 1999;51(2):181–8.Randeva H.S., Schoebel J., Byrne J. et al. Classical pituitary apoplexy: clinical features, management and outcome. Clin Endocrinol 1999;51(2):181–8.Ayuk J., McGregor E.J., Mitchell R.D., Gittoes NJ. Acute management of pituitary apoplexy – surgery or conservative management? Clin Endocrinol 2004;61(6):747–52. DOI: 10.1111/j.1365-2265.2004.02162.xAyuk J., McGregor E.J., Mitchell R.D., Gittoes NJ. Acute management of pituitary apoplexy – surgery or conservative management? Clin Endocrinol 2004;61(6):747–52. DOI: 10.1111/j.1365-2265.2004.02162.xGruber A., Clayton J., Kumar S. et al. Pituitary apoplexy: retrospective review of 30 patients – is surgical intervention always necessary? Br J Neurosurg 2006;20(6):379–85.Gruber A., Clayton J., Kumar S. et al. Pituitary apoplexy: retrospective review of 30 patients – is surgical intervention always necessary? Br J Neurosurg 2006;20(6):379–85.Zayour D.H., Selman W.R., Arafah B.M. Extreme elevation of intrasellar pressure in patients with pituitary tumor apoplexy: relation to pituitary function. J Clin Endocrinol Metabol 2004;89(11):5649–54. DOI: 10.1210/jc.2004-0884Zayour D.H., Selman W.R., Arafah B.M. Extreme elevation of intrasellar pressure in patients with pituitary tumor apoplexy: relation to pituitary function. J Clin Endocrinol Metabol 2004;89(11):5649–54. DOI: 10.1210/jc.2004-0884Arafah B.M., Harrington J.F., Madhoun Z.T., Selman W.R. Improvement of pituitary function after surgical decompression for pituitary tumor apoplexy. J Clin Endocrinol Metabol 1990;71(2):323–8.Arafah B.M., Harrington J.F., Madhoun Z.T., Selman W.R. Improvement of pituitary function after surgical decompression for pituitary tumor apoplexy. J Clin Endocrinol Metabol 1990;71(2):323–8.Кадашев Б.А., Кутин М.А., Калинин П.Л. и др. Сравнительная оценка результатов хирургического лечения пациентов с аденомами гипофиза, инфильтрирующими кавернозный синус, с применением различных хирургических методик. Вопросы нейрохирургии им. Н.Н. Бурденко 2004(3):14.Kadashev B.A., Kutin M.A., Kalinin P.L. et al. Comparative evaluation of the results of surgical treatment of patients with cavernous sinus-infiltrating pituitary adenomas using various surgical techniques. Voprosy neirokhirurgii imeni N.N. Burdenko = Burdenko’s Journal of Neurosurgery 2004(3):14. (In Russ.).Кутин М.А., Кадашев Б.А. Аденомы гипофиза, врастающие в кавернозный синус: диагностика и варианты лечения. Вопросы нейрохирургии им. Н.Н. Бурденко 2003;2:27–30.Kutin M.A., Kadashev B.A. Pituitary adenomas growing into the cavernous sinus: diagnosis and treatment methods. Voprosy neirokhirurgii imeni N.N. Burdenko = Burdenko’s Journal of Neurosurgery 2003;2:27–30. (In Russ.).Калинин П.Л., Фомичев Д.В., Кутин М.А. и др. Эндоскопическая эндоназальная хирургия аденом гипофиза (опыт 1700 операций). Вопросы нейрохирургии им. Н.Н. Бурденко 2012;76(3):26–33.Kalinin P.L., Fomichev D.V., Kutin M.A. Endoscopic endonasal surgery of pituitary adenomas (experience of 1700 operations). Burdenko’s Journal of Neurosurgery 2012;76(3):26–33. (In Russ.).Астафьева Л.И., Калинин П.Л., Фомичев Д.В. и др. Эндоскопическое эндоназальное транссфеноидальное удаление аденом гипофиза. Опыт 4000 операций. Достижения персонализированной медицины сегодня – результат практического здравоохранения завтра. Сборник тезисов VII Всероссийского конгресса эндокринологов 2016:411.Astafieva L.I., Kalinin P.L., Fomichev D.V. et al. Endoscopic transnasal resection of pituitary adenomas. Experience of 4000 surgeries. Successes of personalized medicine today – result of practical healthcare tomorrow. Proceedings of the VII All-Russia Congress of Endocrinologists 2016:411. (In Russ.).Кутин М.А., Кадашев Б.А. и др. Рентгенологические аспекты кровоизлияний в аденомы гипофиза. Вестник рентгенологии и радиологии 2017;98(3):123–9. DOI: 10.20862/0042-4676-2017-98-3-123-129Kutin M.A., Kadashev B.A., Kalinin P.L. et al. Radiological aspects of hemorrhage into pituitary adenomas. Journal of Radiology and Nuclear Medicine 2017;98(3):123–9. (In Russ.). DOI: 10.20862/0042-4676-2017-98-3-123-129Chang C.V., Felicio A.C., Toscanini A.C. et al. Pituitary tumor apoplexy. Arquivos de neuro-psiquiatria 2009;67(2A):328–33.Chang C.V., Felicio A.C., Toscanini A.C. et al. Pituitary tumor apoplexy. Arquivos de neuro-psiquiatria 2009;67(2A):328–33.Semple P.L., de Villiers J.C., Bowen R.M. et al. Pituitary apoplexy: do histological features influence the clinical presentation and outcome? J Neurosurg 2006;104(6):931–7. DOI: 10.3171/jns.2006.104.6.931Semple P.L., de Villiers J.C., Bowen R.M. et al. Pituitary apoplexy: do histological features influence the clinical presentation and outcome? J Neurosurg 2006;104(6):931–7. DOI: 10.3171/jns.2006.104.6.931McFadzean R.M., Doyle D., Rampling R. et al. Pituitary apoplexy and its effect on vision. Neurosurgery 1991;29(5):669–75.McFadzean R.M., Doyle D., Rampling R. et al. Pituitary apoplexy and its effect on vision. Neurosurgery 1991;29(5):669–75.Fraioli B., Esposito V., Palma L., Cantore G. Hemorrhagic pituitary adenomas: clinicopathological features and surgical treatment. Neurosurgery 1990;27(5):741–7; discussion 747–8.Fraioli B., Esposito V., Palma L., Cantore G. Hemorrhagic pituitary adenomas: clinicopathological features and surgical treatment. Neurosurgery 1990;27(5):741–7; discussion 747–8.Cardoso E.R., Peterson E.W. Pituitary apoplexy: a review. Neurosurgery 1984;14(3):363–73.Cardoso E.R., Peterson E.W. Pituitary apoplexy: a review. Neurosurgery 1984;14(3):363–73.Muller W.P.H. Zur Klinik, und Autologie der Massenblutungen in Hypophysenadenome. Dtsch A Nervenklinik 1953;170:326–36.Muller W.P.H. Zur Klinik, und Autologie der Massenblutungen in Hypophysenadenome. Dtsch A Nervenklinik 1953;170:326–36.Grant F.C. The surgical treatment of pituitary adenomas. JAMA 1939;113:1279–82.Grant F.C. The surgical treatment of pituitary adenomas. JAMA 1939;113:1279–82.Poussant T.Y., Barnes P.D., Anthony D.C. et al. Hemorrhagic pituitary adenomas of adolescence. Am J Neuroradiol 1996;17:1907–12.Poussant T.Y., Barnes P.D., Anthony D.C. et al. Hemorrhagic pituitary adenomas of adolescence. Am J Neuroradiol 1996;17:1907–12.Кутин М.А., Астафьева Л.И., Кадашев Б.А. и др. Кровоизлияние в аденомы гипофиза (питуитарная апоплексия). Основные представления о причинах развития и выборе методов лечения. Обзор литературы. Вестник неврологии, психиатрии и нейрохирургии 2016;(3):50–62.Kutin M.A., Astafieva L.I., Kadashev B.A. et al. Haemorrhages within pituitary adenomas (pituitary apoplexy). Main conceptions about the causes of development and selection of treatment methods: literature review. Vestnik nevrologii, psikhiatrii i neirokhirurgii = Bulletin of Neurology, Psychiatry and Neurosurgery 2016;(3):50–62. (In Russ.).Кутин М.А., Астафьева Л.И., Кадашев Б.А. и др. Эпидемиология и клинические проявления кровоизлияний в аденомы гипофиза. Вестник неврологии, психиатрии и нейрохирургии 2016;(8):62–9.Kutin M.A., Astafieva L.I., Kadashev B.A. et al. Epidemiology and clinical symptoms of pituitary apoplexy. Vestnik nevrologii, psikhiatrii i neirokhirurgii = Bulletin of Neurology, Psychiatry and Neurosurgery 2016;(8):62–9. (In Russ.).Кутин М.А., Ротин Д.Л., Шишкина Л.В. и др. Морфологические аспекты кровоизлияний в опухоли гипофиза. Злокачественные опухоли 2016;3(19):11–6. DOI: 10.18027/2224-5057-2016-3-11-16Kutin M.A., Rotin D.L., Shishkina L.V. et al. Morphological feature of haemorrhages into pituitary adenomas. Malignant Tumours 2016;(3):11–6. (In Russ.). DOI: 10.18027/2224-5057-2016-3-11-16Jefferson G. Extrasellar extentions of pituitary adenomas. Proc R Soc Med 1940;33:433–58.Jefferson G. Extrasellar extentions of pituitary adenomas. Proc R Soc Med 1940;33:433–58.Bi W.L., Dunn I.F., Laws E.R. Jr. Pituitary apoplexy. Endocrine 2015;48(1):69–75. DOI: 10.1007/s12020-014-0359-yBi W.L., Dunn I.F., Laws E.R. Jr. Pituitary apoplexy. Endocrine 2015;48(1):69–75. DOI: 10.1007/s12020-014-0359-yКадашев Б.А. Аденомы гипофиза. Клиника, диагностика, лечение. М.: Триада, 2007. 367 с.Кадашев Б.А. Аденомы гипофиза. Клиника, диагностика, лечение. М.: Триада, 2007. 367 с.Калинин П.Л., Фомичев Д.В., Кутин М.А. Эндоскопическая транссфеноидальная хирургия. М.: Шико, 2017.Kadashev B.A. Pituitary adenomas. Clinical manifestations, diagnosis, treatment. Moscow: Triada, 2007. 367 p. (In Russ.).Dubuisson A.S.B., Stevenaert A. Classical pituitary tumour apoplexy: clinical features, management and outcomes in a series of 24 patients. Clin Neurol Neurosurg 2007:63–70.Калинин П.Л., Фомичев Д.В., Кутин М.А. Эндоскопическая транссфеноидальная хирургия. М.: Шико, 2017.Bills D.C., Meyer F.B., Laws E.R. Jr. A retrospective analysis of pituitary apoplexy. Neurosurgery 1993;33(4):602–8; discussion 608–9.Kalinin P.L., Fomichev D.V., Kutin M.A. Endoscopic transsphenoid surgery. Mowcow: Shiko, 2017. (In Russ.).Onesti S.T., Wisniewski T., Post K.D. Clinical versus subclinical pituitary apoplexy: presentation, surgical management, and outcome in 21 patients. Neurosurgery 1990;26(6):980–6.Dubuisson A.S.B., Stevenaert A. Classical pituitary tumour apoplexy: clinical features, management and outcomes in a series of 24 patients. Clin Neurol Neurosurg 2007:63–70.Asaithambi G. Carotid artery compression from pituitary apoplexy. QJM: Monthly Journal of the Association of Physicians 2015;108(2):159. DOI: 10.1093/qjmed/hcu153Bills D.C., Meyer F.B., Laws E.R. Jr. A retrospective analysis of pituitary apoplexy. Neurosurgery 1993;33(4):602–8; discussion 608–9.Bujawansa S., Thondam S.K., Steele C. et al. Presentation, management and outcomes in acute pituitary apoplexy: a large single-centre experience from the United Kingdom. Clin Endocrinol 2014;80(3):419–24. DOI: 10.1111/cen.12307Onesti S.T., Wisniewski T., Post K.D. Clinical versus subclinical pituitary apoplexy: presentation, surgical management, and outcome in 21 patients. Neurosurgery 1990;26(6):980–6.Maccagnan P., Macedo C.L., Kayath M.J. et al. Conservative management of pituitary apoplexy: a prospective study. J Clin Endocrinol Metabol 1995;80(7):2190–7.Asaithambi G. Carotid artery compression from pituitary apoplexy. QJM: Monthly Journal of the Association of Physicians 2015;108(2):159. DOI: 10.1093/qjmed/hcu153Bujawansa S., Thondam S.K., Steele C. et al. Presentation, management and outcomes in acute pituitary apoplexy: a large single-centre experience from the United Kingdom. Clin Endocrinol 2014;80(3):419–24. DOI: 10.1111/cen.12307Bujawansa S., Thondam S.K., Steele C. et al. Presentation, management and outcomes in acute pituitary apoplexy: a large single-centre experience from the United Kingdom. Clin Endocrinol 2014;80(3):419–24. DOI: 10.1111/cen.12307Maccagnan P., Macedo C.L., Kayath M.J. et al. Conservative management of pituitary apoplexy: a prospective study. J Clin Endocrinol Metabol 1995;80(7):2190–7.Maccagnan P., Macedo C.L., Kayath M.J. et al. Conservative management of pituitary apoplexy: a prospective study. J Clin Endocrinol Metabol 1995;80(7):2190–7.

The authors declare that there are no conflicts of interest present.