ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2019) 63 P1058 | DOI: 10.1530/endoabs.63.P1058

Pituitary apoplexy: diagnosis, management and outcome in 44 patients

Imen Gargouri1, Faten Hadjkacem1, Mouna Mnif1, Mohamed Walha2, Nabila Rekik1, Nadia Charfi1, Fatma Ayadi3 & Mohamed Abid1

1Endocrinology Department, Sfax, Tunisia; 2Department of Clinical Chemistry, Sfax, Tunisia; 3Departement of Clinical Chemistry, Sfax, Tunisia.

Introduction: Pituitary apoplexy (PA) is a rare incident defined by the occurrence of necrosis and/or haemorrhage of the pituitary gland. PA is a clinical syndrome characterized by the sudden onset of headache, vomiting, visual impairment and decreased consciousness in some cases. The objectives of our study are to describe its clinical, biological and imaging features as well as the management of PA in the region of Sfax.

Patients and methods: It is a retrospective study including a group of patients in the Endocrinology department of Hedi Chaker Hospital in Sfax over an 18-year period (2000–2017). The data collected was analysed by the SPSS version 20 software.

Results: This study included 44 patients (20 women versus 24 men) with a mean age of 50.04±12.58 years. Fourteen patients (31.8%) had a pituitary adenoma known before the onset of apoplexy, secreting in 9 cases. Precipitating factors have been found in 14 cases (31.8%). Dopaminergic agonist treatment and head trauma were so far the commonest predisposing factors. In 2 cases, the PA was incidental. In the remaining 42 cases (95.5%), the PA was discovered during the investigation of a clinical symptomatology. Headache was present in 37 patients (84.1%). Visual disturbances were reported by 33 patients (75%), who were predominantly affected by visual acuity and visual field disturbance. We Partial pituitary insufficiency was confirmed after hormonal screening in 41 patients requiring hormonal replacement. Pituitary MRI was performed in 42 patients confirming the diagnosis of PA, and CT guided the diagnosis in the remaining 2 cases. Transsphenoidal surgery was performed in 24 patients and transient diabetes insipidus was noted postoperatively in two patients. Conservative management was adopted in the remaining 20 cases. The mean duration of follow-up was 43.7±53.2 months. During follow-up, partial hypopituitarism persisted in 24 cases and he persistence of a tumor in 13 patients and tumor growth recurrence in a single patient after long term follow-up.

Conclusion: The low incidence of PA makes it difficult to establish guidelines for its management. However monitoring for tumour growth and assessing for pituitary gland function need to be continued post-operatively considering the possible risk of its recurrence.

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