Outcomes of Pituitary Function following Pituitary Apoplexy: A Retrospective Review at a Single Institution

Background: Pituitary apoplexy is a result of pituitary hemorrhage or infarction often resulting in pituitary dysfunction and visual field defects. While the indication for surgical decompression is typically based on acute visual changes, both vision and pituitary function affect patient outcomes. The authors report on outcomes in pituitary function in patients with pituitary apoplexy.

Methods: The authors performed a retrospective analysis of patients presenting to a single-institution with pituitary apoplexy from 2013 to 2022. Patient records were reviewed for: outcomes of pituitary function, surgical decompression of the hemorrhagic/infarcted lesion, level of resection, and pathology of the lesion. Any patient missing data for pituitary function outcome was excluded. Statistical analysis was performed using the Fisher’s exact test.

Results: Forty-one patients were identified with pituitary apoplexy of which 31 patients had information regarding pituitary function. Six patients (19%) had normal pituitary function while 25 patients (81%) had pituitary dysfunction (8 patients with hypopituitarism, 8 patients with hypothyroidism, 11 patients with secondary adrenal insufficiency, and 3 patients with hypogonadism). Twenty seven (87%) patients underwent surgical decompression via a trans-sphenoidal resection of the lesion. On pathologic analysis, 23 patients had a nonfunctioning pituitary macroadenoma, 1 patient with prolactinoma, 2 patients with adrenocorticotropic hormone (ACTH) secreting adenoma and 1 patient with follicle-stimulating hormone (FSH)/luteinizing hormone (LH) secreting adenoma. 11 patients had reported gross total resection (GTR), 4 patients had reported near total resection (NTR), and 6 patients had reported subtotal resection (STR). Comparison of patients with and without surgical decompression revealed no statistical difference in outcomes of any pituitary dysfunction or secondary adrenal insufficiency (p = 0.56 and p = 1, respectively). Comparison of patients with GTR with non-GTR revealed no statistical difference in outcomes of pituitary dysfunction or secondary adrenal insufficiency (p = 0.62 and p = 0.36, respectively).

Conclusion: Patients with pituitary apoplexy often have long-term pituitary dysfunction. Nearly two-thirds of patients with pituitary apoplexy required long-term steroid replacement for secondary adrenal insufficiency. While vision deficits for patients with pituitary apoplexy often resolve, pituitary dysfunction is persistent causing long-term morbidity. Surgical decompression and extent of resection did not affect outcomes of pituitary dysfunction or secondary adrenal insufficiency.

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Artikel online veröffentlicht:
05. Februar 2024