Endocrine Abstracts

Introduction: Pituitary apoplexy is a rare clinical emergency with an incidence of 2–7% in pituitary adenomas. There does not exist any evidence-based standards of optimum care for the patients. A key controversy in management is related to the functioning of acute neurosurgical intervention. The nature of clinical presentation precludes robust randomised controlled trials. Practical guidelines are derived from high-quality observational studies. On this background, we report the management of pituitary apoplexy in a large cohort of patients treated at a single tertiary referral centre.

Methods: This retrospective study evaluates the clinical presentation, management and clinical outcomes presenting with pituitary apoplexy during 2020–2021.

Results: 80 patients with 34 females were included. Among these patients, 10 patients had been previously diagnosed with a pituitary tumour. The common symptoms were visual disturbance, headache, diplopia and cranial nerve involvement. 32 patients had undergone surgery, while 48 patients were conservatively managed. All 32 patients had visual disturbances, while 59% of them had recovered fully. Among these patients, 76% made full recovery while 33 had visual disturbances. In the surgical group, 84% required hydrocortisone, 15% withdrew treatment, 69% required thyroxine, 34% required sex steroids, 9% started growth hormone. In the conservatively managed patients, 79% started hydrocortisone, 13% stopped doing so, 60% required thyroxine, 46% started sex steroids, 19% started growth hormones.

Conclusion: This data represents the largest case series from a single centre. We propose that patients with acute apoplexy who have mild or stable symptoms/signs can be managed conservatively with careful monitoring; only rarely is there a need to change from conservative to surgical management in these patients.