Endocrine Abstracts

Background: Pituitary apoplexy has been reported in around 2% of surgically treated adenomas. Around 45% of all pituitary tumours presenting with apoplexy are non-functioning ones (NFAs). Currently, no data exist on recurrence rates in patients with NFAs who have had classical apoplexy.

Aim: We therefore, put together our data aiming to provide the first reliable series on recurrence rates in patients with NFA and classical pituitary apoplexy.

Patients and methods: All patients with NFA presenting with acute apoplexy to our Department between 1985 and 2008 and treated by surgery combined or not with radiotherapy were studied (inclusion criteria: sudden onset of clinical features including headaches, visual disturbance, ophthalmoplegia, nausea/vomiting, alteration of mental status combined with signs of pituitary haemorrhage on imaging and/or histological evidence of haemorrhage or necrosis in the pituitary gland). Recurrence was diagnosed on the basis of radiological appearances and the follow-up was estimated form the time of surgery until last available imaging.

Results: Thirty-two patients were identified [23 males, median age 58.5 yrs (29–85)]. Mean follow-up was 65 months (3–211). Five subjects received adjuvant radiotherapy after surgical removal. No patient offered radiotherapy had tumour recurrence. Three patients treated by surgery only (3/27, 11.1%) were diagnosed with relapse at a median time 51 months after resection (12, 51, 86 months – further managed by surgery, surveillance and radiotherapy, respectively). All had had partial removal of their tumour. Kaplan Meier analysis for those treated surgically only showed recurrence rates 4.3% and 13.9% at 48 and 72 months, respectively.

Conclusions: In this first study to assess pure classical apoplexy and recurrence rates, there is a significant degree of recurrence. This seems to be less than non-irradiated NFAs, but it is still significant and therefore, patients with pituitary apoplexy need regular surveillance imaging, in order to detect recurrence early.