Endocrine Abstracts

Background: Pituitary apoplexy (PA) is a rare endocrine and neurosurgical syndrome characterized by pituitary hemorrhage/infarction. SARS-CoV-2 infection and vaccination have been described as possible risk factors for PA, but the real impact of COVID-19 burden on PA epidemiology is still unknown.

Purpose: To investigate the incidence of PA in the pandemic period during exposure to SARS-CoV-2 infection and vaccination and possible peculiar clinical characteristics of COVID-related PA.

Methods: Of retrospectively evaluated 581 consecutive patients who underwent transsphenoidal surgery (TNS) at Neurosurgery Department of IRCCS San Raffaele Hospital between Jan 2017 and Dec 2022, 21 were diagnosed with PA. Patients were divided into pandemic (Jan2020-Dec2022) and pre-pandemic groups (Jan2017-Dec2019). Data on known risk factors for PA, clinical presentation signs/symptoms, radiological and pituitary hormonal status at inpatient evaluation and 6 months after surgery were collected. During the pandemic, a SARS-CoV-2 nasopharyngeal swab was obtained at hospital admission in all patients.

Results: Patients with PA had a mean age of 53.9±14.8 years, a mean BMI of 26.6±3.77 kg/m² and were more frequently males (14/21). Number of TNS procedures decreased by 16.7% from pre- to pandemic with similar incidence of PA (12 -3.8%- vs 9 -3.4%-, respectively). Between the two groups, there were no differences among known risk factors for PA (P=0.95), clinical presentation (P=0.82), radiological (P=0.128) and hormonal (P=0.21) status at PA onset. Only pathophysiological difference was that in the pandemic group 3 patients (33%) were highly suspect for COVID-19-related PA: of them 1 experienced PA during hospitalization for SARS-CoV-2 pneumonia and 2 within 8 weeks after mRNA SARS-CoV-2 vaccination. Moreover, during pandemic a significantly better hormonal axes recovery (58.3% vs 22.2%, P=0.002) and also a trend toward a prompter neurological improvement at six-month follow-up (P=0.091) was observed.

Conclusion: Overall PA incidence was not increased during the SARS-CoV-2 period although data highlight that one third of the patients operated for PA during the pandemic had relevant COVID-19-related issues. This finding may represent paradigm shift in pathogenesis and clinical course of PA in pandemic era although data may be interpreted with caution possibly either overestimating (a casual association can not be excluded) or even underestimating (less severe cases may not be operated upon and shifted to conservative medical treatment) the impact of COVID-19 on PA. Multicenter collaborative studies enrolling a higher number of patients are needed to confirm our results.