Endocrine Abstracts

Introduction

Pituitary apoplexy is a rare entity characterized by abrupt hemorrhage and/or ischaemia of the constituents of sella turcica. It usually occurs in a previously unsuspected pituitary tumor. It may have an acute or subclinical presentation and it may represent a neuroendocrinological emergency.

Aim

This study aims to analyze predisposing or precipitating factors, clinical status, imaging and hormonal features, therapeutic management and its outcome for patients presenting with pituitary apoplexy.

Methods

We performed a retrospective analysis which included 36 patients diagnosed with pituitary apoplexy (we included both acute and subclinical presentations), evaluated during 2019 in Department of Pituitary and Neuroendocrine Pathology at the ’C.I. Parhon’ The National Institute of Endocrinology Bucharest, Romania.

Results

36 patients with pituitary apoplexy were included (19 men, 17 women; mean-age at diagnosis 49.2 years, range 14-72 years). Half of the patients presented a classical pituitary apoplexy episode, whilst the other half had oligosymptomatic pituitary haemorrhage described on CT or MRI scan. Only 9 (25%) cases were previously known to have a pituitary adenoma (non-secreting adenoma in most cases). 8 patients (25%) presented at least one precipitating factor, hypertension being the most common. The top 3 symptoms of apoplexy in our patients are headache (44.4%), visual abnormalities (44.4%) and digestive manifestations (22.2%). 23 patients (63.8%) underwent neurosurgical intervention, 11 of them having typical clinical presentation. 75% of the patients had remnant intrasellar mass after the apoplectic event. At diagnosis, corticotropic deficiency was noted to be the most common deficit in patients with classical pituitary apoplexy (4/7 patients) while gonadotropic deficiency had the greatest prevalence in subclinical cases (6/9 patients). 25 patients (69.4%) remained with longterm hormone replacement therapy. Out of 16 cases with visual disturbances, 11 patients were operated and 5 managed conservatively. 9 of the operated patients and all cases with conservative treatment had improvement in vision. 4 cases (11%) developed postoperative diabetes insipidus.

Conclusions

Pituitary apoplexy should be managed with a multidisciplinary approach. Although there is an important visual recovery in these patients, the outcome of pituitary function is less favourable.