6 SVOA Neurology Case Series SVOA Neurology ISSN: 2753-9180 Necrotic Apoplexy of Pituitary Adenoma; A Report of Three Cases Chafik HANDIS 1 , Salim MEZIANI 1 , Yacine FELISSI 1 *, Radhia AIT CHALAL 2 , Leila AHMED ALI 3 , Amel ADIMI 3 , N Soumaya FEDALA 3 and Abdelhalim MORSLI 1 1 Mohamed Lamine Debaghine University Hospital, Department of Neurosurgery, Algiers University, Faculty of Medicine, Algiers, Algeria. 2 Mohamed Lamine Debaghine University Hospital, National Centre of Medical Imaging, Algiers University, Faculty of Medicine, Algiers, Algeria. 3 Mohamed Lamine Debaghine University Hospital, Department of Endocrinology Algiers University, Faculty of Medicine, Algiers, Algeria. *Corresponding Author: Dr. Yacine FELISSI, Mohamed Lamine Debaghine University Hospital, Department of Neurosurgery, Algiers University, Faculty of Medicine, Algiers, Algeria. Received: January 22, 2023 Published: February 07, 2023 DOI: https://doi.org/10.58624/SVOANE.2023.04.083 Abstract Apoplexy is relatively a rare clinical expression or revelation of pituitary adenoma. Necrotic apoplexy is a subgroup with unique findings in its different aspects. Early surgical resection through the transsphenoidal route is the main modality for their management. We report three cases of patients with necrotic apoplexy. we reviewed the circumstances of revelation, the imaging features, surgical findings, and the results of histological analysis. The age of patients ranged between 22 and 53 years old. All patients complained of headaches and visual disorders. At the MRI evaluation, they had the same radiological features of necrotic apoplexy. They received endoscopic endonasal surgery for the resection and the histological analysis confirmed the presence of necrosis areas in the sampled tissues. Necrotic apoplexy is a rare and unique clinical entity. At the imaging, it appears as a solid sellar mass, iso to hyperintense in both sequences T1 and T2. during the surgical removal, the lesion is yellowish and poorly bleeding without hemorrhagic contents. The histological studies reveal large areas of necrosis in similar lesions. Keywords: Apoplexy, necrosis, endoscopy. Introduction Pituitary apoplexy (PA) is a clinical presentation related to a hemorrhagic or infarction event of a pre -existing pituitary adenoma (1). It regroups several symptoms including visual acuity and field disturbances, hypopituitarism, nerve palsies, and even consciousness disorders (2). This situation is reported to be present in 2 to 12% of all pituitary adenomas(3). Therefore, this condition can be a possible evolution for adenoma or one of their revelation’s ways. Despite that it’s de- scribed as a major emergency, PA is described as the mechanism of spontaneous remission in secreting adenoma as it was reported in a few cases of acromegaly (4, 5).beyond all of these scenarios, PA could be subclinical without typical symptoms as headache or visual acuity deterioration (6). Necrotic apoplexy (NA) is a subgroup of infarction PA with unique findings during the surgical resection or during re- viewing histopathological reports of resected lesions (7). according to one significant retrospective study, NA is made mainly by two indispensable criteria that are: the first is the intraoperative finding of a specific aspect of the adenoma represented by a cheese-like aspect and poorly bloody mass and the second is the histological studies that will show mainly, large areas of necrosis (7). Our knowledge about NA lacks precision and this is due to the rarity of similar cases (8), therefore it remains interesting to analyze different aspects whether the pathophysiology or the efficient manage- ment of this pathology. The work reports three cases of NA of PA with all the previously mentioned characteristics of definition. we have re- viewed the clinical presentation, hormonal evaluations, and surgical management of these patients. this study is an addi- tional reference for this rare entity within the pituitary pathology that must be further elucidated with larger series.