Pituitary Apoplexy: Unveiling Predictors and Outcomes”

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.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
05 February 2024