Endocrine Abstracts

Objective: To determine the prevalence and the associated factors of pituitary apoplexy (PA) in non-functional pituitary adenomas (NFPA).

Patients and Methods: A retrospective analytical study of 35 patients followed for NFPA between 2000 and 2022 was conducted at our institution. A pituitary magnetic resonance imaging (MRI) scan was performed in all patients.

Results: The mean age was 52.1±11.4 years, with a male predominance (61.3%). The primary reason for consultation was pituitary tumor syndrome (77.4%). Rarely, signs of hypopituitarism may inaugurate the clinical presentation (9.7%). Headache and visual disturbances dominated the initial presentation in 90.3% and 80.6% of cases, respectively. Underlying pituitary insufficiencies were frequently observed, namely those affecting the corticotropic (67.7%), thyroid (41.9%), and gonadotropic (41.9%) sectors. A pituitary MRI showed a macroadenoma in 90%. The prevalence of pituitary apoplexy in NFPA was 25.8%. Clinical factors significantly associated with PA were: inaugural hypopituitarism (OR=0.22; P=0.018), gonadotropic insufficiency (OR=4.25; P=0.023), lactotropic insufficiency (OR=5; P=0.013) and bilateral visual field amputation (OR=1.636; P=0.049). Tumor size >4cm (OR=0.19; P=0.011) and the presence of hemorrhagic remodeling (OR=5.83; P=0.001) were also predictive factors of pituitary apoplexy.

Discussion: Pituitary apoplexy is the clinical expression of a hemorrhage and/or ischemia of a pituitary adenoma. This situation may require urgent surgical treatment. Our work allows us to identify patients with NFPA at risk of apoplexy based on several accessible clinical and radiological markers, such as tumor size >4cm, the presence of inaugural hypopituitarism, and significant visual field amputation.

References: 1. Wildemberg, Luiz Eduardo, et al. "Apoplexy in nonfunctioning pituitary adenomas." Pituitary 21.2 (2018): 138-144. 2. Nawar, Rita N., et al. "Analytic review: pituitary tumor apoplexy: a review." Journal of Intensive Care Medicine 23.2 (2008): 75-90.