Endocrine Abstracts (2002) 3 P205

Outcomes in the management of pituitary apoplexy; a conservative approach may be prudent

EJ McGregor, J Ayuk & NJL Gittoes

Division of Medical Sciences, University of Birmingham, UK.

Due to the infrequency of pituitary apoplexy, there are no robust evidence-based guidelines for optimum care of these patients. The key controversy surrounds the role of acute neurosurgical intervention. Over recent years we have adopted a relatively conservative approach and the aim of this study was to determine whether this 'non-intervention' affected long-term outcome in a recent cohort of patients. 19 patients (8 female) presented between 1994-2001. Mean age at diagnosis was 49 years (range 26-67) and mean follow up duration was 2.8 (0.8-7.5) years. The most common presenting symptoms were headache (100%), nausea/vomiting (79%) and visual deficits (74%). 9 patients (47%) underwent transsphenoidal surgery, the main indication being worsening visual deficit. 5 patients in the surgical group had ocular paresis that resolved in 40% post-surgery, and 4 had visual field defects with recovery in 75% post-surgery. Reduced visual acuities improved in 2 of 3 patients. 4 patients (44%) had post-operative CSF leak, 5 (55%) developed diabetes insipidus. Conservative management was reserved for patients with absent or resolving visual deficits at presentation (n=10), and visual recovery occurred in 100% of these patients. 4 patients with ocular paresis and 3 with visual field defects all made full recoveries. Long-term steroid and thyroid hormone replacement was required in 89% of patients managed neurosurgically and in 80% of those managed conservatively, while sex steroid replacement was required in 67% and 100% of patients managed neurosurgically and conservatively respectively. Our findings suggest that patients presenting with pituitary apoplexy in whom visual deficits are stable or improving should be managed expectantly as there is no identifiable beneficial effect on visual recovery in those treated early with surgery. Moreover, at latest follow up, no patient in the 'conservative' group had required surgery or pituitary radiotherapy and none showed evidence of tumour recurrence on MRI.

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