Endocrine Abstracts

Background: Pituitary apoplexy (PA) is a rare, potentially life-threatening endocrine emergency, due to abrupt pituitary haemorrhage and/or infarction, usually within a pituitary adenoma. PA most commonly presents with severe headache, visual and oculomotor activity disturbances, nausea/vomiting and/or altered mental status. The outcome is variable and difficult to predict. Most proposed risk factors are hypertension (HTN), diabetes mellitus (DM), and anticoagulant treatment. Optimal management of PA is still controversial due to rarity of the condition.

Aim: To assess the characteristics and the outcomes of our patients with PA.

Material and methods: We retrospectively analysed medical records of patients with PA managed at the national tertiary care centre from 2010 to 2023. We collected data for adenoma size, hormone deficiency, visual and oculomotor activity disturbances at the time of presentation and after at least 3 months later. We also checked for operative treatment or spontaneous reduction of adenoma when not operated on, presence of HTN, DM or anticoagulant treatment.

Results: Sixteen patients (11 males, 68,8%) of median age 66,5 (IQR 20) with PA were identified during the studied period. At presentation, 14 of them (87,5%) had adrenocorticotropic and 15 (93,8%) thyrotropic deficiency, 7 (43,8%) had hyponatremia, and 2 (12,5%) developed diabetes insipidus (DI). Median sodium was 134 (IQR 7,25) mmol/l, overall. Visual disturbances were present in 6 (37,5%) and oculomotor palsy in 10 (62,5%) patients. Eight (50%) patients were treated surgically, including all 6 patients with visual disturbances. Visual field improvement was noted in all patients and oculomotor palsy resolved completely. HTN was present in 6 (37,5%), DM in 4 (25%) patients, while two (12,5%) patients received anticoagulant treatment. Median adenoma size was 22,5 (IQR 12,50) mm. There was no statistically significant difference in adenoma size between surgically and conservatively managed patients (P=0,162). Adenoma decreased in size in 4 (50%) patients without surgery. The adenoma shrinkage was statistically significant from median 18,5 (IQR 9,75) mm to 13 (IQR 7,50) mm (P=0,044). At follow-up, 12 (75%) had adrenocorticotropic and thyrotropic deficiency, 11 (68,8%) also had secondary hypogonadism, 7 (43,8%) had low IGF-1, 4 (25%) patients had low prolactin levels. Six (37,5%) patients had DI, including 4 after surgery. Multiple hormonal deficiencies were more common in surgically managed patients.

Conclusion: Our observations suggest that conservative management of PA is feasible in carefully selected milder cases without important visual deficit. Further studies on optimal stratification of PA patients are needed.