Case Report: Surgical treatment of feline pituitary apoplexy in 3 cases

BackgroundSurgical treatment of feline pituitary apoplexy has not been previously described.ObjectivesTo describe the clinical course and follow-up of 3 cases of feline pituitary apoplexy.MethodsCases were selected based on histopathological confirmation of pituitary masses with haemorrhagic lesions, following transsphenoidal hypophysectomy. Details of physical examination, diagnostic test results, treatment and follow-up course were retrospectively acquired by review of medical and imaging records.ResultsTwo cats were presented with acute onset of neurologic signs (case 1 and 2), and one cat showed subacute endocrinological dysfunction (case 3). All cases underwent successful transsphenoidal hypophysectomy, followed by intensive care hospitalization and successful discharge. Pituitary apoplexy was identified by histopathological examination of the excised pituitary glands in cases 1, 2, and 3. Imaging findings compatible with pituitary apoplexy were present in all 3 cases, although only case 3 was imaged with a hemorrhage-sensitive sequence, providing unequivocal evidence of intralesional hemorrhage. Case 1 had a survival time at least 716 days, underwent a second transsphenoidal surgery because of tumor recurrence and was subsequently lost to follow-up. Case 2 had a survival time of at least 1,098 days and is still alive at the time of writing this manuscript. In case 3, tumor recurrence was identified radiologically (MRI) at 365 days, and it died during a course of radiation therapy 612 days after transsphenoidal hypophysectomy.Conclusion and clinical importancePituitary apoplexy is a rare condition that also affects cats with large pituitary adenomas. Overall, the cats experienced acceptable clinical recovery and postoperative survival, supporting the feasibility of transsphenoidal hypophysectomy as a therapeutic option for cats with pituitary tumors affected by apoplexy. Notably, a favorable outcome was observed even in the presence of remnant pituitary tissue, as illustrated by the cat that later developed pituitary tumor recurrence.