Endocrine Abstracts

Pituitary apoplexy is a rare syndrome due to a clinically overt hemorrhagic infarction, described in 2–7% of pituitary adenomas. A subclinical usually asymptomatic pituitary hemorrhage and/or infarction may be detected on routine imaging or during histopathological examination in 25–28% of patients with pituitary adenomas.

Aim: We compared the clinical features and evolution of 166 patients with subclinical pituitary apoplexy (SPA) and 46 patients with clinical apoplexy (CA) admitted between 1995 and 2018, diagnosed by suggestive imaging for pituitary haemorrhage and/or pathological exam.

Results: Mean age at diagnostic was 40 years (14–79) for SCA patients and 46 years (16–85) in CA patients, P<0.05. Female to male ratio was 2:1 for SCA and 1:1.7 for CA. Macroadenomas were 86% in SCA and 98% in CA patients. In SCA 100 patients (60%) were diagnosed after previous treatments for the pituitary adenoma and 66 patients per primam (at the diagnosis of the pituitary tumor), while in CA 91% were diagnosed per primam. In SCA about 63% had prolactinomas, while in CA 72% had non-functioning adenomas. Clinically, in SCA 35% had mild-to-moderate headaches (compared to 98% severe headaches in CA), 6% visual field defects (in patients with per primam subclinical apoplexy) versus 80% in CA, none had diabetes insipidus in SCA, compared to 28% in CA patients (P<0.05). Hypopituitarism was recorded in 65% of patients with per primam SPA and in 42% of those previously treated, as compared to 96% in CA patients, P<0.01. Pituitary surgery was done in 17% of SCA patients and 91% of CA patients, radiotherapy in 6% SCA and 13% of CA patients, pharmacological treatment (mainly dopamine agonists) in 76% SCA and 17% CA, no treatment in 19% SCA and 9% CA patients. In patients with SPA, after median follow-up of 71 months, the cure rate was 4.5% in per primam SPA and 9% in the second group (none spontaneous). In CA, after median follow-up of 78 months, cure occurred in 25% of patients (spontaneous in 4% of patients). Tumor growth after SPA was recorded in 12–13% of patients and after CA in 2% (P<0.05). Conclusion. Subclinical apoplexy in pituitary adenomas is more frequent in males and in prolactinomas, while clinical apoplexy is more frequent in women and in non-functioning adenomas. Subclinical apoplexy does not seem to increase the cure rate in pituitary adenomas.