Endocrine Abstracts

Introduction: Pituitary apoplexy is a rare clinical syndrome that often involves headache, visual deficits, and endocrine dysfunction resulting from infarction or hemorrhage of a pituitary tumor. Due in part to the rare nature of this condition, there are few large studies on pituitary apoplexy described in the literature. Here, we present a large single center retrospective cohort study of patients with pituitary apoplexy managed surgically or conservatively.

Methods: This is a retrospective cohort study; data was collected from prospectively entered information in our Halifax Neuropituitary Clinic’s database. Medical records of patients with symptomatic pituitary apoplexy treated at from January 2000 to October 2022 were reviewed. Patients treated surgically typically presented with deterioration of vision or loss of consciousness, whereas conservative management was typically selected for patients with no visual field deficits or who were otherwise unable to undergo surgery due to patient-specific medical factors. Patient demographics, endocrinologic values, clinical outcomes, and cases of tumor recurrence were analyzed. Descriptive statistics were reported as means, percentages, and standard error of the mean. Independent two-samples t-tests (and α=0.05) were used for statistical analyses between patients treated surgically versus conservatively.

Results: Eighty-three (n=83) patients with symptomatic pituitary apoplexy met our inclusion criteria. The average age at diagnosis was 50.4±1.6 years. Seventy-two percent of tumours (n=60) were non-functioning adenomas. Functioning (but hormonally uncontrolled) adenomas made up 8.4% of cases (n=7), and other parasellar lesions comprised 13.2% (n=11). Sixty (72.3%) patients were treated surgically, while the remaining twenty-three patients (27.7%) were treated conservatively. At time of initial presentation, mean endocrinological values were as follows: GH 1.1±0.6 µg/l (n=28), IGF-1 155.1±29.6 µg/l (n=38), Prolactin 318.0±286.1 µg/l (n=49), FSH 7.6±1.3 IU/L (n=50), LH 3.8±0.8 IU/L (n=7), TSH 1.39±0.17 mIU/l (n=52), Cortisol 330.4±35.8 nmol/l (n=54). There were no significant differences in endocrinological values at time of presentation between patients treated surgically compared to those treated conservatively. At time of presentation, patients treated surgically had a tumor size in maximum dimension of 2.7±1.4 cm vs 1.6±0.5 cm for those treated conservatively (P=0.0003). Fifteen percent (n=9) of patients treated surgically underwent an additional surgery (mean 2.8±2.0 years from index), of which 67% (n=6) were secondary to tumor recurrence.

Conclusions: This is one of the largest reported series of pituitary apoplexy with long-term follow-up. A subset of surgically treated patients will require additional intervention, highlighting the importance of ongoing follow up in this population.