Endocrine Abstracts (2012) 28 P243

Acute Management of Pituitary Apoplexy: Experience in 70 consecutive cases

Biju Jose1, Lavanya Pelluri1, Rosalind Mitchell2, Neil Gittoes1 & John Ayuk1

1Department of Endocrinology, University hospital birmingham, Birmingham, United Kingdom; 2Department of Neurosurgery, University hospital birmingham, Birmingham, United Kingdom.

Introduction: Pituitary apoplexy is an uncommon medical emergency with a reported incidence in pituitary adenomas of 2–7%. UK guidelines on the management of pituitary apoplexy have recently been published. On this background we analysed the management of pituitary apoplexy at a single tertiary centre.

Methods: A retrospective analysis was performed to evaluate clinical presentation, management and clinical outcomes in a cohort of patients, who presented acutely with pituitary apoplexy during the period 1989–2010.

Results: Data for 70 patients with pituitary apoplexy were collected; 32 female, 38 male. Eight had an established diagnosis of pituitary tumour, four prolactinoma and one non-functioning pituitary adenoma. The most common symptoms at presentation were headache (90%) and visual disturbances (71%). 29 patients (41%) underwent surgery during the acute admission. The reasons for surgery were deteriorating vision or no improvement (n=16), hemiparesis (n=2), cranial nerve palsies (n=7), tumour size (n=3) and patient choice (n=1). Among the 29 patients in the surgical group, 59% with visual disturbances had full recovery, while 56% of those in the conservatively managed group achieved full recovery. Comparable numbers required long term hormone replacement therapy (Table 1). At latest follow up, four patients were deceased from unrelated causes. Four patients in the surgical group required radiotherapy for enlarging tumours. In the conservatively managed group one patient later underwent surgery and another required radiotherapy, both due to increasing tumour size.

Conclusion: Our data represent the largest case series from a single centre and support the UK guidelines’ recommendations that patients with mild or stable symptoms and signs can be managed conservatively with careful monitoring, and only rarely is there a need to change from conservative to surgical management in these patients.

Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.

Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.

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