Objectives: Pituitary Apoplexy, either as a result of haemorrhage or infarction, remains a rare but serious Endocrine Disorder, requiring urgent clinical assessment and management. The British Endocrine Society (BES) has set out recommendations regarding the diagnosis and management of pituitary apoplexy, but there remains little published literature depicting this. The aim of this study was to compare our current Management practise of Pituitary Apoplexy with the recommendations set out by The British Endocrine Society (BES).
Methods: In this study, we retrospectively collected data on all new diagnoses of Pituitary Apoplexy in a 12 month period, ranging from 1/1/2015 to 31/12/2015. We assessed data including patient demographics, presenting symptoms, Type of Pituitary tumour, time to first assessment of visual fields and acuity, time to Specialist Endocrine assessment, time to Neurosurgical assessment, and reassessment of visual fields and acuity at the time of discharge with comparison at presentation. Data was collected from Patient Records and Patient imaging software.
Results: 4 male patients were diagnosed with pituitary apoplexy. Mean patient age was 61 years (46 to 76 years). All 4 suffered from diplopia and impaired visual acuity. All 4 were Macroadenomas. All 4 were commenced on IV Saline within 24 hours. 2 out of the 4 (50%) were commenced on Parenteral Hydrocortisone within 24 hours. Mean Time to Endocrine review was 31.6 hours (Range 22.03 hours to 45.5 hours). Mean time to Neurosurgical review was 48.5 hours (Range 25.9 hours to 100.4 hours). All 4 were managed conservatively. Mean time to first formal Visual acuity/field assessment 54.2 hours (Range 31.2 hours to 71.2 hours).
Conclusion: Overall, we are adhering to the BES Apoplexy recommendations. All 4 patients showed objective improvements clinically and in visual acuity following treatment. However, the length of time to specialty input and administration of parenteral Hydrocortisone remained suboptimal.
Disclosure of of Interest
18 - 21 May 2019
European Society of Endocrinology