Endocrine Abstracts

JOINT1837

Aims and Objectives: To determine the prevalence, incidence and outcomes of pituitary apoplexy patients presenting acutely in Malta.

Methodology: Twenty-nine patients presenting with pituitary apoplexy between 1980 and 2023 were retrospectively identified. The prevalence and incidence rates were calculated. Clinical presentation, endocrinological, radiological findings and outcomes of all patients with pituitary apoplexy were analysed and compared between the two cohorts who were treated conservatively or with early surgical intervention, taking into consideration serum prolactin levels at diagnosis. The Pituitary Apoplexy Score (PAS) was applied retrospectively.

Results: Five from 29 patients had a known pituitary adenoma. The prevalence for pituitary apoplexy was 4.61/100,000 individuals (NFPA 3.69/100,000; functional adenoma 0.92/100,000) and the overall SIR was 0.19/100,000/year (NFPA 0.144/100,000/year; functional adenoma 0.047/100,000/year). Prevalence rates and SIR were higher amongst males (prevalence 8.08/100,000 in males vs 0.78/100,000 in females). 92% of the patients who presented with apoplexy were macroadenomas, whilst 8% were microadenomas. The median age for apoplexy was found to be 51 years (IQR 42-58); higher in the NFPA subtype; 55 (IQR 49.5-63) when compared to 43 (IQR 38.5-45.25) in the functional group. Visual field defects were more prevalent when baseline prolactin levels were less than 5ng/ml; 68.75% vs 42.86% (P = 0.014). Complete pituitary function was preserved in 7.18%, whilst 78.57% showed panhypopituitarism and 14.29% exhibited partial hypopituitarism. Whilst 72.41% were initially managed conservatively, 27.59% were surgically treated and underwent trans sphenoidal decompression of the sella, within 7 days of presentation. There was no difference in terms of endocrinological outcome at 3 or 12 months between the surgically and conservatively treated group. At 12 months, 7.14% retained pituitary function, whereas 75% experienced panhypopituitarism and 17.86% exhibited partial hypopituitarism. Three from 27 patients (11.11%) were reported to have regrowth post apoplexy and 1 patient had recurrence of apoplexy in the tumour remnant. Utilising a lower PAS threshold, a comparative analysis showed that 87.5% of patients who underwent early surgery had a PAS ≥4, whilst 26.32% of those treated conservatively had a PAS ≥4 (P <0.001).

Conclusions: Through thorough case identification, this study provides both prevalence and incidence rates of pituitary apoplexy in a well-defined population in Malta. Clinical sequelae and various treatment modalities have been studied to better understand this rare condition.