{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:19:57Z","timestamp":1790266797552,"version":"4.1.0"},"reference-count":47,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2015,6]]},"abstract":"<jats:sec>\n<jats:title>OBJECT<\/jats:title>\n<jats:p>Pituitary adenomas occasionally undergo infarction, apoplexy, which often destroys much of the tumor. It is well known that apoplexy can be precipitated by several acute factors, including cardiac surgery, other types of surgery, trauma, insulin infusion, and stimulation with administration of hypothalamic releasing factors.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The prior focus on mechanisms underlying pituitary apoplexy has been on these acute events. Less attention has been given to the endogenous features of pituitary tumors that make them susceptible to spontaneous infarction, despite that most pituitary apoplexy occurs in the absence of a recognized precipitating event. The authors examine intrinsic features of pituitary adenomas that render them vulnerable to apoplexy\u2014features such as high metabolic demand, paucity of angiogenesis, and sparse vascularity, qualities that have previously not been linked with apoplexy\u2014and argue that it is these features of adenomas that underlie their susceptibility to spontaneous infarction. The sensitivity of freshly cultured pituitary adenomas to hypoglycemia is assessed.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Adenomas have high metabolic demand, limited angiogenesis, and reduced vessel density compared with the normal gland. Pituitary adenoma cells do not survive in the presence of reduced or absent concentrations of glucose.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>The authors propose that the frequent ischemic infarction of pituitary adenomas is the product of intrinsic features of these tumors. These endogenous qualities create a tenuous balance between high metabolic demand and marginal tissue perfusion. Thus, the tumor is vulnerable to spontaneous infarction or to acute ischemia by any event that acutely alters the balance between tumor perfusion and tumor metabolism, events such as acute systemic hypotension, abruptly decreased supply of nutrients, hypoglycemia with insulin administration, or increase in the tumor's metabolic demand due to administration of hypothalamic releasing factors. It may be possible to take advantage of these intrinsic features of pituitary adenomas by using aspects of this vulnerability for development of new approaches for treatment.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2014.10.jns141720","type":"journal-article","created":{"date-parts":[[2015,4,11]],"date-time":"2015-04-11T00:27:01Z","timestamp":1428712021000},"page":"1444-1449","source":"Crossref","is-referenced-by-count":70,"title":["Apoplexy of pituitary adenomas: the perfect storm"],"prefix":"10.3171","volume":"122","author":[{"given":"Edward H.","family":"Oldfield","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, University of Virginia Health Sciences Center, University of Virginia, Charlottesville, Virginia; and"},{"name":"Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marsha J.","family":"Merrill","sequence":"additional","affiliation":[{"name":"Surgical Neurology Branch, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-jns141720","series-title":"J Clin Endocrinol Metab","first-page":"1789","article-title":"The dominant role of increased intrasellar pressure in the pathogenesis of hypopituitarism, hyperprolactinemia, and headaches in patients with pituitary adenomas","volume":"85","author":"Arafah","year":"2000"},{"key":"b2-jns141720","series-title":"J Comput Assist Tomogr","doi-asserted-by":"publisher","first-page":"832","DOI":"10.1097\/00004728-199109000-00021","article-title":"Regression of pituitary macroadenoma after pituitary apoplexy: CT and MR studies","volume":"15","author":"Armstrong","year":"1991"},{"key":"b3-jns141720","series-title":"Clin Endocrinol (Oxf)","doi-asserted-by":"publisher","first-page":"747","DOI":"10.1111\/j.1365-2265.2004.02162.x","article-title":"Acute management of pituitary apoplexy\u2014surgery or conservative management?","volume":"61","author":"Ayuk","year":"2004"},{"key":"b4-jns141720","series-title":"J Comput Assist Tomogr","doi-asserted-by":"publisher","first-page":"815","DOI":"10.1097\/00004728-198709000-00014","article-title":"Rapid decrease in amino acid metabolism in prolactin-secreting pituitary adenomas after bromocriptine treatment: a PET study","volume":"11","author":"Bergstr\u00f6m","year":"1987"},{"key":"b5-jns141720","series-title":"J Comput Assist Tomogr","doi-asserted-by":"publisher","first-page":"384","DOI":"10.1097\/00004728-198705000-00003","article-title":"Amino acid distribution and metabolism in pituitary adenomas using positron emission tomography with D-[11C]methionine and L-[11C]methionine","volume":"11","author":"Bergstr\u00f6m","year":"1987"},{"key":"b6-jns141720","series-title":"J Nucl Med","first-page":"610","article-title":"PET as a tool in the clinical evaluation of pituitary adenomas","volume":"32","author":"Bergstr\u00f6m","year":"1991"},{"key":"b7-jns141720","series-title":"J Clin Invest","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1172\/JCI116165","article-title":"Expression of the vascular permeability factor\/vascular endothelial growth factor gene in central nervous system neoplasms","volume":"91","author":"Berkman","year":"1993"},{"key":"b8-jns141720","series-title":"J Neurosurg","doi-asserted-by":"publisher","first-page":"586","DOI":"10.3171\/jns.1984.61.3.0586","article-title":"Pituitary apoplexy associated with a triple bolus test. 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