Endocrine Abstracts

Objective: The management of pituitary apoplexy, a rare emergency neuroendocrine condition, is controversial. The aim of the present study was to compare the outcome of patients with pituitary apoplexy managed either by a conservative or surgical approach.

Methods: A retrospective cohort study including patients diagnosed between 2007 and 2018 in a tertiary French university hospital. Pituitary apoplexy score was retrospectively applied in a perspective of therapeutic decision support.

Results: Forty-six patients were treated for a pituitary apoplexy either with conservative management (n = 27) or surgery (n = 19). At initial evaluation, visual field defects and visual acuity impairments were more frequent in patients from the surgery group. At one year there were no statistical differences in the rates of complete/near-complete resolution of visual field defects (100% vs 91.7%), visual acuity impairment (100% vs 87.5%) and cranial nerve palsies (83.3% vs 100%), between conservative and surgical treatment groups. Endocrine function prognosis was poor regardless of the treatment. Pituitary apoplexy score (n = 42) was at 3.4 on average in the early surgery group and 1.4 in the conservative treatment/delayed surgery group. Among patients with a score <4, 31.3% were operated at first line and did not present better outcomes than patients managed conservatively. 80% of patients with a score ≥ 4 underwent surgery.

Conclusions: Pituitary apoplexy score may be a reliable parameter for defining therapeutic strategy. Patients with non-severe and non-progressive neuro-ophthalmological deficits can be managed conservatively without negative impact on outcomes, thus surgery should be reserved foronly those patients with a Pituitary apoplexy score ≥4.