Endocrine Abstracts

Pituitary apoplexy (PA) is a rare syndrome that requires urgent assistance. It is due to ischemia or hemorrhage of pituitary tissue, almost always inside a pituitary tumor. PA may be the first manifestation of a neuroendocrine tumor or occur during follow up.

Objective: To describe the characteristics of patients with PA treated in the Department of Endocrinology and Nutrition in the last 10 years and study the presence of possible risk factors for it.

Patients and method: Descriptive, single-center, retrospective study. We selected from electronic records 48 patients with the diagnosis of PA treated in the Endocrinology and Nutrition Department from 2010 to 2020. Demographic, clinical, biochemical, radiological and anatomopathological data were collected. The results are expressed as mean and standard deviation (SD) in the case of quantitative variables or percentage in the case of qualitative variables (SPSS 25.0).

Results: 67% of the patients were men with a median age at diagnosis of 58.5 years (SD 13.9). As vascular risk factors they presented: hypertension (50%), diabetes (9.5%), and dyslipidemia (42.9%). Other coexisting clinical situations were: pregnancy (1), rheumatoid arthritis (1), Wegener’s disease (1) and postoperative coronary bypass (1). The diagnosis was established with an average of 3 days from the onset of symptoms. The most frequent symptoms were: headache (79.1%), visual alterations (69.8%), nausea/vomiting (51.2%) and fluid and electrolyte disorders (20.9%), especially hyponatremia (50%). 40.5% of the patients had a known pituitary neuroendocrine tumor: pituitary macroadenomas (82%), pituitary macroadenomas with invasion of the cavernous sinus (45.2%), non-functioning tumors (52.9%) and prolactinoma treated with cabergoline (17.9%). Most patients (90.4%) presented some hormonal deficit: LH/FSH (76.3%), TSH (50%), GH (44.7%), ACTH (42.8%), ADH (2.3%). Panhypopituitarism was present in 26.2%. No patient passed away in the acute moment. 71.4% of the cases were treated with endoscopic transsphenoidal surgery for persistent headache and/or visual alterations. 76.2% of the patients continued with hormonal replacement treatment after surgery, of which 7 patients (21.9%) recovered total pituitary function, with an average of 4.6 months (SD 2.6) after the event.

Conclsions: - Pituitary apoplexy is more frequent in males and in pituitary neuroendocrine tumors bigger than 1 cm especially in cases with cavernous sinus invasion.

- Hypertension and dyslipidemia are very prevalent in patients with pituitary apoplexy.

- Despite being a condition that requires urgent assistance, the diagnosis is delayed for days from the onset of symptoms even with patients with known pituitary tumors.