Endocrine Abstracts

Introduction: The risk of pituitary apoplexy (PApopl) is up to 9.5%. In 80% of cases, it is the first manifestation of the disease.

Material and methods: The study included 94 PApopl from 1 day up to 9 years. Conservative treatment was performed in 37 cases, and 59 were operated on including 14 giant posthemorrhagic cysts. The probability of resorption – it is possible in 85%, instead of cysts (the probability of resorption of ~ 15%). After 3 months, for PApopl, resorption of the tumor is sharply reduced. The use of Dexamethasone in the treatment shows an important role: slightly increases the probability of resorption and significantly increased the probability of visual oculomotor improvement. Regression hypopituitarism was shown in 87.5% of cases, and it was shown in 17.3% of cases without Dexamethasone. Most of the tumors did not show aggressive growth. Mutation p53 was not found. Only half of the observations identified receptors for epidermal growth factor (EGFR). In almost all cases revealed the expression of Cyclin D1, but the presence of mitosis in tumor cells revealed only a quarter of them. The level of Ki-67 did not exceed 5% in most cases. Quite a separate group of tumors should be considered a tumor with giant posthemorrhagic cysts. This is actually a separate disease. Treatment of such patients is associated with an extremely high risk of complications, and mortality reaches 30%. The most effective method of treatment was transsphenoidal endoscopic cyst evacuation followed by prolonged drainage into sphenoid sinus, in cases without intraoperative CSF-leak.

Conclusion: In contrast to the conventional view, when the most PApopl need for urgent removal, we offer a differentiated approach to the treatment choice depended on the size and radiological characteristics of the tumor and the dynamics of the patient condition during the conservative therapy.