Endocrine Abstracts (2011) 26 P229

Clinical and subclinical apoplexy in nonfunctioning pituitary tumors: clinical features, management and outcome

Leonor Gomes1, Isabel Paiva1, Cristina Ribeiro1, Jacinta Santos1, Alexandra Vieira1, Márcia Alves1, Sofia Gouveia1, Joana Saraiva1, Olinda Rebelo1,2 & Manuela Carvalheiro1

1Serviço de Endocrinologia, Diabetes e Metabolismo, Hospitais da Universidade de Coimbra, Coimbra, Portugal; 2Serviço de Neuropatologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal.

Background: Pituitary apoplexy occurs when a tumor undergoes acute hemorrhage, infarct, or both. This often leads to acute severe symptoms (clinical) but can also occur without them and diagnosed on CT/MRI, surgery, pathology (subclinical). To investigate clinical and subclinical apoplexy in nonfunctioning tumors (n=221) from our database.

Design: Retrospective review of clinical presentation, tumor characteristics and outcome of 24 patients, 11 females and 13 males, with pituitary apoplexy.

Results: Subclinical apoplexy occurred in 15 and clinical in 9 patients. They represented 10.9% of nonfunctioning macroadenomas. Subclinical was more frequent on females (81.8 vs 46.2%). Age at diagnosis was similar (subclinical 47.2±15.4 vs 46.3±16.2 years in clinical). Symptoms duration in subclinical was 24.4±45.3 vs 34.1±43.8 months in clinical. Neurological, endocrinological and ophthalmological symptoms were present in 86.7, 80.0, 73.3% of subclinical and in 88.9, 55.6, 77.8% of clinical. Ophthalmoplegia in subclinical 6.7 vs 22.2% of clinical. There was suprasselar extension in subclinical 86.7 vs 100% in clinical, parasellar in 13.3 vs 33.3%, and infrasellar in 40 vs 66.7% respectively. Tumor diameter in subclinical was 25.0±7.9 vs 30.0±11.0 mm in clinical. Surgery was performed in all but three cases, none underwent radiotherapy. Endocrinological evaluation before and after treatment showed in subclinical deficits of GH 66.7 vs 57.1%, FSH/LH 76.9 vs 64.3%, TSH 46.2 vs 42.9%, ACTH 23.1 vs 37.7% and in clinical 100 vs 100%, 100 vs 85.7%, 40 vs 83.3%, 25 vs 85.7% respectively. Treatment was effective in improving vision (subclinical 57.1 vs 42.8% for clinical) and ophthalmoplegia. Disease progression occurred in subclinical 20.0 vs 11.1% of clinical, after a follow-up of 8.2±4.4 vs 9.4±9.6 years respectively.

Conclusions: Apoplexy occurred in 10.9% of nonfunctioning pituitary tumors with a higher rate of subclinical type. In clinical apoplexy, tumors were larger and male gender more frequent. Hypopituitarism and neurophtalmological alterations were high and only the last one improved after treatment. Clinical apoplexy had higher rate of morbidity but lower disease progression. Although pituitary apoplexy is not total predictable it is important to be aware of neurological and endocrinological symptoms in order to perform earlier diagnosis.

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