Acute Degenerative Changes in Adenomas of the Pituitary Body—with Special Reference to Pituitary Apoplexy

D EGENERATIVE changes in pi tui tary adenomas and their a endan clinical manifestations occur not infrequently yet they have been mentioned in only a few of the more complete descriptions of these tumors. These changes usually consist of small hemorrhages and areas of necrosis with cys t formation, reparat ive fibrosis and sometimes calcification. Some writers relate such lesions to the apparent arrest of acromegaly or to the rapid development of dyspituitarism. However, in most instances these degenerative changes are regarded as un impor tan findings without precise relationship to symptoms and without significant effect on the growth of the adenoma. In the routine examination of the brains of individuals who have died unexpectedly we have several times discovered tumors of the p i tu i tary gland in which widespread necrosis and /o r extensive hemorrhage had occurred. Clinically, these changes were associated with a sudden onset of neurological symptoms such as ophthahnoplegia, blindness, stupor or coma and they have resulted in dea th within a few hours to days. Extensive lesions of this type have seldom been described. In fact, a review of the l i terature disclosed only 5 cases showing similar symptomatology and pathological findings. The following cases are presented, therefore, in order to call at tention to these severe retrogressive pi tu i tary lesions.