ECE2018 Poster Presentations: Pituitary and Neuroendocrinology Pituitary - Clinical (101 abstracts)
Pituitary apoplexy: 15 years of experience
Bernardo Marques 1 , Diana Oliveira 2, , Mara Ventura 2 , Adriana Lages 2 , Nelson Cunha 2 , Diana Catarino 2 , Lúcia Fadiga 2 , Margarida Bastos 2, , Sandra Paiva 2 , Isabel Paiva 2 , Leonor Gomes 2, & Francisco Carrilho 2
1Endocrinology Department – Portuguese Institute of Oncology of Coimbra FG, EPE, Coimbra, Portugal; 2Endocrinoloy, Diabetes and Metabolism Department, Centro Hospitalar e Universitário de Coimbra, EPE, Coimbra, Portugal; 3Faculty of Medicine, Coimbra University, Coimbra, Portugal.
Introduction: Pituitary apoplexy (PA) is an endocrine emergency and usually presents with sudden headache and visual fields changes. Pituitary function assessment should be performed promptly and repeated throughout follow-up, regardless of the choice of treatment.
Methods/design: Retrospective analysis of patients diagnosed with PA admitted to an Endocrinoloy Department of a tertiary hospital between 2002 and 2017. Review of patients’ medical records and assessement the following parameters: clinical evaluation, imaging, pituitary deficiencies and treatment at the time of the episode, two months later and by the last evaluation.
Results: We evaluated 17 patients (65% were male), mean age 55±18 years, mean follow-up time 3 years. Four patients had personal history of pituitary adenoma, two of which were non-functioning and two, ACTH-secreting. Hypertension and antiplatelet therapy were the most frequently identified risk factors. Clinical presentation included sudden headache in all patients, decreased visual acuity (38%), visual field deficit (35%) and ophthalmoparesis (43%). A pituitary adenoma was identified in 11 of the 13 patients without known pituitary disease (median diameter: 25 mm). At the time of the apoplexy, hypogonadism was detected in 11/14 patients, hypothyroidism in 9/16, adrenal insufficiency in 5/13 and growth hormone deficiency in 6/13. Twelve patients underwent surgical treatment. Histological analysis revealed gonadotroph adenoma in 4 patients, corticotroph in 2, somatotroph in 2, lactotroph in 1, null cell in 1 and necrotic findings in 2. At the time of hospital discharge, 13 patients were receiving hydrocortisone and 7 levothyroxine. Most of the operated patients had persistence of disease on imaging test after 3–6 months (7/11). At the time of the last evaluation, most patients had insufficiency of two or more pituitary axes. The most common deficits were adrenal (11/16) and gonadal (10/16). There was recovery of ophthalmologic impairment in most operated patients who initially presented with ophtalmoparesis/visual field deficits (6/7).
Conclusion: In this study, surgical treatment was the preferred therapeutic option, which allowed for recovery of visual impairment, despite little recovery of pituitary insufficiency. Patients submitted to conservative treatment had a favourable outcome. Despite being an endocrine emergency, pituitary apoplexy can have a favourable outcome if correctly identified and treated.
Article tools
My recent searches
My recently viewed abstracts
Authors
Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
© Bioscientifica 2024 |
Privacy policy |
Cookie settings
BiosciAbstracts
Bioscientifica Abstracts is the gateway to a series of products that provide a permanent, citable record of abstracts for biomedical and life science conferences.
Find out more