Objective: To describe the experience of pituitary apoplexy from a single-centre modern series.
Methods: We retrospectively reviewed the case notes of patients presenting to Salford Royal NHS Foundation Trust between February 2005 and April 2014 with pituitary apoplexy.
Results: A total of 32 cases (20 males) presenting with classical apoplexy were identified, with a mean age at presentation of 54 years (range 2288 years). 11 patients (34.4%) were managed conservatively and 21 patients surgically. All surgeries were carried out by one of the two pituitary surgeons in our centre. Emergency surgery was carried out in 11 patients. Visual symptoms were present in a higher proportion of patients in the surgical group as compared to the conservative group (87.5% vs 63.6%). The surgical cohort also experienced more severe visual symptoms. The incidence of hypopituitarism at presentation was also higher in the surgical group (88.2% vs 63.6%). All patients in the surgical group showed good improvement or complete resolution of their visual symptoms. The incidence of hypopituitarism was higher in patients who had surgery compared to those managed expectantly (90.5% vs 63.6%). A higher proportion of patients who received emergency surgery had visual symptoms and hypopituitarism at presentation (90.9 and 90.0%) as compared to patients who received elective surgery (80.0 and 75.0%). The Visual recovery and hypopituitarism post procedure was similar in both groups.
Discussion: The incidence of hypopituitarism is high in pituitary apoplexy. In our cohort, patients with more severe symptoms were more likely to undergo surgery. Visual outcomes were good in the surgical group. There was no significant difference in endocrine or visual outcomes between patients who had emergency or elective surgery.