Endocrine Abstracts

Introduction: The term “pituitary apoplexy” (PA) describes the appearance of abrupt hemorrhage and/or ischaemia of the constituents of sella turcica, usually in a pre-existing pituitary tumor. The presentation of this syndrome may be acute or subclinical.

Objective: This study aims to assess clinical, imaging and hormonal features and the outcomes following surgery or conservative treatment among pituitary adenoma patients presenting with PA.

Patients and Design: Retrospective analysis which included 36 case-records of patients with PA, evaluated during one year in Department of Pituitary and Neuroendocrine Pathology at the “C.I. Parhon” The National Institute of Endocrinology Bucharest, Romania.

Results: 36 patients (19 men, 17 women) were identified. The mean-age at diagnosis was 49.2 years. Half of the patients presented an acute PA episode, whilst the other half had a-/oligosymptomatic intratumoral haemorrhage based on imaging evaluation. Only 25% of cases were previously known to have a pituitary adenoma (mainly non-functional adenoma). Most important symptoms of apoplexy in our patients were headache (44.4%), visual abnormalities (44.4%) and digestive manifestations (22.2%). 23 patients (63.8%) underwent surgery, while the rest were managed conservatively. 75% of the patients had remnant intrasellar mass after PA. Regardless of treatment choice, in 85.3% cases a tumor remnant was present after treatment. Corticotropic deficiency was the most common deficit in patients with classical PA (4/7 patients) while gonadotropic deficiency was frequent in subclinical cases (6 /9 patients). More than half (69.4%) remained with longterm hormone replacement therapy. 16 cases presented with visual manifestations and 11 of them underwent surgery. 9 of the operated patients and all cases with conservative treatment had improvement in vision.

Conclusions: A multidisciplinary approach is needed when symptoms or signs of ischaemia in pituitary adenomas appear. The visual recovery in these patients is notable, but the outcome of pituitary function is less encouraging.