Predictive Clinical and Surgical Factors Associated with Recurrent Apoplexy in Pituitary Adenomas

Recurrent pituitary apoplexy is a rare clinical condition often requiring urgent surgical intervention. First-time pituitary apoplexy has a low prevalence of 0.6 to 10% among preexisting adenomas. Recurrent apoplexy subsequently occurs in less than 10% of those cases. As with the initial apoplectic event, recurrent apoplexy is characterized by sudden-onset headache, vision loss, altered mental status, and severe endocrinopathy. To date, the predictive factors associated with recurrent apoplexy have not been well studied.

This study sought to determine the risks underlying recurrent apoplexy and provide a more clear operative picture going forward.

A retrospective chart review was performed for all consecutive patients diagnosed and surgically treated for pituitary apoplexy from 2004 to 2021; the diagnosis was confirmed with MRI. Recurrent apoplexy was defined as a readmission at a distinct time point. Univariate analysis using the chi-squared test and t-test was performed to identify risk factors associated with recurrent apoplexy.

A total of 115 patients were diagnosed with pituitary apoplexy with 11 patients readmitting with recurrent apoplexy. There were no significant differences in demographic factors such as age, hypertension, or anticoagulation use. Patients with recurrent apoplexy were less likely to present with headache or ophthalmoplegia. There were no differences in tumor locations, cavernous sinus invasion, or tumor volumes. Recurrent apoplexy was associated with prior radiation (27.3 vs. 0.0%, p = 0.0001) and prior subtotal resection (90.9 vs. 10.6%, p = 0.0001) compared with first-time apoplexy. Three of 11 patients in the recurring group had received prior radiation; 10/11 had prior subtotal resections. The mean time to recurrent apoplexy was 48.3 months and no differences in overall follow-up were seen between groups.

Recurrent pituitary apoplexy represents a rare and poorly understood event. Prior subtotal resection and radiation treatment are associated with an increased risk. Importantly, no differences in overall follow-up were observed between groups. Given that 90.9% of recurrent apoplexy patients had an initial subtotal resection, this study emphasizes the importance of performing the most complete resection possible at the primary apoplectic event. Future researchers should consider extrapolating from larger sample sizes and conducting further analysis of the long-term clinical sequelae following recurrent apoplexy.

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Artikel online veröffentlicht:
15. Februar 2022