ECE2024 Poster Presentations Pituitary and Neuroendocrinology (120 abstracts)
Prognostic value of the pituitary apoplexy score for predicting hormonal and visual recovery of patients with pituitary apoplexy: results from a spanish multicentric study
María Noelia Sánchez Ramírez 1 , Carlos Perez 2 , Igor Paredes 3 , Alberto Acitores Cancela 4 , Pablo García Feijoo 2 , Cristina Álvares Escolá 5 , María Calatayud 6 , María Soledad Librizzi 6 , Alfonso Lagares 3 , Víctor Rodríguez Berrocal 4,7 & Marta Araujo Castro 1,8
1University Hospital Ramón y Cajal, Department of Endocrinology and Nutrition, Madrid, Spain; 2University Hospital La Paz, Department of Neurosurgery, Madrid, Spain; 3University Hospital 12 de Octubre, Department of Neurosurgery, Madrid, Spain; 4University Hospital Ramón y Cajal, Department of Neurosurgery, Madrid, Spain; 5University Hospital La Paz, Department of Endocrinology, Madrid, Spain; 6University Hospital 12 de Octubre, Department of Endocrinology, Madrid, Spain; 7University Hospital Puerta del Sur, Department of Neurosurgery, Madrid, Spain; 8Institute for Biomedical Research Ramón y Cajal, Department of Endocrinology and Nutrition, Madrid, Spain
Aim: Evaluate the predictive value of the Pituitary Apoplexy Score (PAS) for predicting hormonal and visual recovery after surgery or conservative management of patients with pituitary apoplexy (PA).
Methods: Multicenter retrospective study of patients presenting with clinical PA in three Spanish tertiary hospitals between 2008 and 2022. The PAS was calculated following the UK Pituitary Apoplexy Guidelines Development Group evaluation grid.
Results: A total of 71 patients with PA were included, with a median age of 60 years and 67.6% were male. Most patients had macroadenomas, with the exception of one with microadenoma. A total of 33 cases had a PAS≥3 and 25 ≥4. Only 16 patients had a Glasgow Coma Scale lower than 15 at diagnosis. There were 20 patients with visual loss, 17 with diplopia and 13 with visual loss and diplopia. Of the whole cohort, 61 patients underwent pituitary surgery and 10 were conservatively managed. After surgery or conservative treatment, 38.5% of the 52 patients with hormonal deficits at diagnosis recovered the pituitary function and 61.2% of the 49 patients with visual involvement at diagnosis had a normal visual function. Based on ROC curve, the optimal threshold in the PAS to identify those patients with a lower probability of visual recovery was 3, and for hormonal recovery was 4. Patients with PAS≥3 had larger tumors (30.3±9.49 vs 23.7±12.80 mm, P=0.019) and panhypopituitarism was four times more common (OR 4.0, 95% CI 1.32 to 12.15) than in patients with PAS<3. The proportion of patients who underwent conservative management did not differ between patients with PAS≥3 and PAS<3. Patients with a score ≥3 had a probability of non-visual recovery 3.8 times higher than those with a score <3 (OR 3.8, 95% CI 1.01 to 13.96). These differences lost significance after adjusting by tumor size (adjusted OR 3.68, 95% CI 0.96 to 14.07). No differences in the rate of hormonal recovery (OR 0.61, 95% CI 0.19 to 1.93) nor in the rate of visual normalization (OR 0.69, 95% CI 0.22 to 2.19) were observed between patients with a PAS≥4 and PAS<4.
Conclusion: PAS score equal or greater than 3 seems more accurate than the classical threshold of 4 to identify those patients with PA with a lower chance of visual recovery after surgical/conservative management. This association is related to a larger tumor size in patients with PAS score exceeding 2.
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Endocrine Abstracts
ISSN 1470-3947 (print) | ISSN 1479-6848 (online)
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