The outcomes of pituitary apoplexy with conservative treatment: experiences at a single institution.

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The outcomes of pituitary apoplexy with conservative treatment: experiences at a single institution.

World Neurosurg. 2018 Apr 27;:

Authors: Seo Y, Kim YH, Dho YS, Kim JH, Kim JW, Park CK, Kim DG

Abstract
OBJECTIVE: Pituitary apoplexy is an unpredictable complication caused by hemorrhage or infarction in a pituitary adenoma. We retrospectively analyzed the radiological and clinical outcomes of patients with conservatively managed pituitary apoplexy.
METHODS: A total of 32 patients who had undergone conservative treatment with high-dose corticosteroid replacement were enrolled in this study. This cohort study consisted of 20 male and 12 female patients. The median patient age was 60 years. Five patients had a previously diagnosed pituitary tumor, and one-third of the patients had a history of hypertension.
RESULTS: The median follow-up duration was 50 months. The median tumor volumes at the initial and final assessments were 2.75 cm3 (range, 0.32-10.7) and 0.64 cm3 (range, 0-8.74), respectively. Complete radiographic regression occurred in 9 of the 32 patients, partial regression occurred in 14 patients, and no change in size or progression occurred in 9 patients. Eighteen of the 32 patients had visual disturbances at the initial presentation; in this subgroup, 17 patients showed improvement over the course of the study. One patient had newly developed diplopia related to tumor progression. Nineteen of the 32 patients had at least one hormonal deficiency at the initial assessment, 8 of whom recovered to normal endocrine status. Three patients developed a new hormonal deficiency during the follow-up, and three patients experienced tumor recurrence.
CONCLUSIONS: This study demonstrated the regression of tumors related to pituitary apoplexy, with favorable ophthalmological and endocrinological recovery. Conservative management should be considered in patients without severe or progressive neuro-ophthalmic deficits.

PMID: 29709755 [PubMed - as supplied by publisher]

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