Endocrine Abstracts

Objectives: The rarity of pituitary apoplexy renders it a difficult subject for audit; hence there are no evidence-based standards of optimum care for such patients. The main controversy in management relates to the role of acute surgical intervention. Recently, a more conservative management has been adopted towards patients presenting with this condition. Therefore, it is important to evaluate the differences in outcome between patients submitted to surgical and conservative management.

Methods: A retrospective analysis was performed to evaluate all patients that presented with pituitary apoplexy since 1998 were followed in Hospital de Braga. Clinical presentation, management, and clinical outcomes were evaluated. We then performed a descriptive statistical analysis. Student’s t-test and Pearson’s χ² test or Fisher’s exact test were used for comparing between groups. We admitted a P value <0.05 to be statistically significant.

Results: There are no statistically significant differences in outcome between the patients that had surgery and the patients that followed conservative management, (χ² (1)=0.002; P=0.967; n=50). Differences of statistical significance were found between the 2 groups in the following data: on average, the operated tumors are 11.67 mm bigger than the ones in patients with conservative management, (t(48)=4.925, P<0.001, d=1.375, r²=0.32); there are also differences in para-selar extension, (χ²(4)=16.554; P=0.001; n=50), and infra-selar extension, (χ²(2)=7.935; P=0.013; n=50), with a bigger concentration of significant results in Knosp 1 and Knosp 3. The surgical group also presented a bigger concentration of growth into the sphenoidal sinus, (Adjusted Standardized Residuals >|1,96|).

Conclusion: The conservative management should be considered, without presenting an increased risk for the patients, regardless of clinical presentation, visual deficits, or endocrinal deficits during admission. However, we do recommend that patients presenting with tendentially larger tumor diameter or Knosp should be evaluated on a case-by-case basis in order to determine the best acute management.