Endocrine Abstracts

Background: Pituitary apoplexy (PitApo) has significant associated-morbidity and its management is not yet standardised.

Aim: To describe prevalence and characteristics of PitApo patients in GH deficient (GHD) patients compared with two control populations.

Patients and methods: Patients with ‘infarction-apoplexy’ GHD aetiology code were identified from Pfizer International Metabolic Database (KIMS). Baseline characteristics, GH dosage and 1-year response to GH replacement of PitApo patients were compared with non-functioning pituitary adenoma (NFPA, n=3828) and Sheehan’s syndrome (n=495) control groups.

Results: We identified 151 PitApo patients (0.96% of 15.809 GHD patients), including eight PitApo reported as adverse events during KIMS. Median age at GHD diagnosis was lower in PitApo than NFPA (47.8 vs 51.8 years, P<0.01) and higher than Sheehan’s patients (42.5 years, P<0.001). Gender distribution was similar in PitApo and NFPA groups (68.2% vs 60.8% males). There were no differences in dose between groups regardless of oestrogen use. The proportion of GH-naïve/semi-naïve patients with normal IGF-I after 1 year of GH replacement was similar between PitApo and NFPA (80.4% vs 82.5%) and lower in Sheehan’s (57.8%, P<0.0001 vs PitApo). Median IGF-I SDS 1-year increase was similar in PitApo and NFPA (1.61 vs 1.92) and higher in Sheehan’s (2.59, P<0.05 vs PitApo). Mean age/gender-adjusted serum total cholesterol decreased from baseline in PitApo (−0.76 mmol/l) vs NFPA (−0.32 mmol/l, P<0.05) and Sheehan’s patients (−0.19 mmol/l, P<0.05), while LDL- and HDL-cholesterol changes did not differ. AGHDA-QoL-score reduction (indicating improved QoL) was similar in PitApo and NFPA (−4.33 vs −3.76 points) and higher than Sheehan’s patients (−1.58 points, P<0.01 vs PitApo).

Conclusions: In this large cohort of patients with pituitary apoplexy, representing <1% of GHD patients overall, GH dose and treatment effects were comparable to NFPA controls, except for greater reductions in serum lipids, while Sheehan’s controls attained normal IGF-I less frequently and their QoL improved less.

Disclosure: KIMS is sponsored by Pfizer, Inc. SR is a Marie Curie IEF postdoctoral fellowship recipient (grant no. 303006/2011).