Endocrine Abstracts

Introduction: Pituitary apoplexy is a rare disease which results of haemorrhage and/or infarction of pituitary gland. The optimal management of this problem still remains controversial between surgery and conservative treatment.

Aims: To characterize the clinical presentation, diagnostic workup, treatment and follow up of patients with apoplexy. Methods:Retrospective study of 35 pituitary apoplexy followed in a portuguese hospital from 2006 to 2016.

Results: Thirty-five patients (21 males; mean age, 55.1(15.6) years) were identified. Three patients had subclinical pituitary apoplexy and 9(28%) had more than one emergency evaluation until the diagnosis has been correctly made. Commonest presenting features were acute headache (84.4%), visual impairment (62.5%) and vomiting (15.6%). Five patients were known to have pituitary tumour at presentation, one of them was a Cushing Disease which became cured after PA, and 3 were nonfunctioning adenomas. Nineteen patients had at least one precipitating factor with antiaggregation being the most common (n=4). Twenty patients had hypopituitarism at presentation, 14 had hyponatraemia, 9 had a decreased in level of consciousness and 21 had visual impairment. 78.1% patients proceeded to pituitary surgery and 3 developed diabetes insipidus after that. When we compared those who underwent surgery and those treated conservatively, visual deficits were more common in first group (76% vs 28%, P=0.032) and hyponatremia in the second one (32% vs 86%; P=0.027). There were no more differences between groups in other evaluated factors, namely in Pituitary Apoplexy Score (1.68 (1.21) vs 0.86 (1.21); P=0.124). During follow-up 6(3) years, 1 patient had hypopituitarism reversal after surgery and 11 patients recovered from neuro-ophthalmologic deficits. Three patients passed away and 21 have a MRI without lesion.

Conclusion: The diagnosis of pituitary apoplexy is often delayed as occurred in our population.It is associated with a high rate of anterior hypopituitarism that does not typically recover, unlike the visual symptoms. Patients with visual defects were more likely to be managed surgically.