Introduction: Pituitary apoplexy, occurring in 0.6–10% of pituitary adenoma patients, is characterized
by sudden enlargement due to hemorrhage or necrosis. Its manifestations include abrupt
vision loss, cranial nerve deficits, or altered sensorium. While once deemed an immediate
surgical requirement, the management approach has evolved, with many cases effectively
treated conservatively.
Materials and Methods: We retrospectively and prospectively analyzed all diagnosed pituitary apoplexy patients.
We recorded admission, discharge, and follow-up vision, other deficits, hormonal profiles,
and radiological findings. Patients were categorized based on improvement with conservative
treatment, static condition, or deterioration. Those with significant deficits or
no improvement were surgically treated via the transsphenoidal route, and operative
findings were documented. Univariate and multivariate analyses compared parameters
in the three categories.
Results: A total of 46 patients were enrolled, with only 15 requiring surgery, while the remaining
31 were successfully managed medically. Patients with prolactinoma and apoplexy showed
significant recovery with expectant treatment and cabergoline. Isolated ptosis cases
exhibited notable spontaneous improvement. Radiological findings, specifically Hardy
A and B and KNOSP 1 and 2, were associated with significant improvement. Multivariate
analysis highlighted that female patients had better outcomes with conservative management
than their male counterparts. The nature of radiological lesions (solid, cystic, or
enhancing) did not independently affect outcomes. Among surgically treated patients,
those with early visual deficits displayed favorable visual responses, while socially
blind patients did not show significant improvement.
Discussion and Conclusion: Pituitary apoplexy patients can be initially managed expectantly unless clinical
deterioration occurs. Patients with prolactinomas, smaller lesions, and isolated ptosis
achieve the best outcomes with medical management. Female sex emerges as an independent
favorable factor for clinical improvement. Factors such as lesion characteristics,
hormonal secretion, and age do not significantly influence apoplexy outcomes. Notably,
favorable visual outcomes are primarily observed in cases of early vision loss, while
advanced vision loss rarely shows significant improvement even after surgery.
