Aims: The United Kingdom (UK) guidelines for management of acute pituitary apoplexy recommend the Pituitary Apoplexy Score (PAS) to objectively assess clinical severity of this rare neuro-endocrine emergency. We aimed to apply retrospectively this scoring tool to a large, single centre series of patients with acute pituitary apoplexy, and to determine its applicability in the management of these patients in the acute setting.
Methods: Retrospective study of patients referred to a single UK regional neurosurgical centre from 19852010. Case notes were reviewed and neuro-ophthalmological deficits scored using the PAS tool (based on visual acuity, visual field defects, ocular paresis and the Glasgow Coma Scale). Scores range from 010 with a higher score indicating more significant neuro-ophthalmic impairment.
Results: 51 patients (61% male), mean age 52.4 years (range 1478) were studied. 35/51 (69%) were managed conservatively compared with 16/51 (31%) who underwent emergency pituitary surgery (within 7 days of presentation).The mean PAS in conservatively managed patients was 1.8 (range 05), and mean PAS in surgically treated patients was 3.75 (range 16). Thirty (86%) of the conservatively managed patients had a PAS <4, and 11 (69%) of the surgically treated patients had a PAS ≥ 4. 19/51 patients had bilateral visual field defects of which, 13 (68%) underwent emergency surgery compared with 6 (32%) who were managed expectantly.
Conclusion: Clinical severity based on a PAS ≥ 4 appeared to influence the management towards emergency surgical intervention. Our data add to existing literature that PAS can be a useful tool to monitor conservatively managed patients and may prompt consideration for surgery if the score increases during the period of observation. As previously suggested by the UK guideline development group, clinical outcomes of management decisions based on PAS can only be assessed using this tool in a future prospective study.
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.