Factors Predicting Neuroendocrine Recovery Following Transsphenoidal Surgery in Pituitary Apoplexy Patients

Abstract

Pituitary apoplexy is a rare clinical syndrome. Only a few studies have examined factors associated with recovery of neuroendocrine functions following transsphenoidal surgery. This study aimed to identify factors associated with neuroendocrine recovery following surgery for pituitary apoplexy. The records of pituitary apoplexy patients who underwent transsphenoidal surgery at Songklanagarind Hospital between January 2005 and December 2020 were retrospectively reviewed. The primary outcomes were the recoveries of preoperative visual acuity (VA), visual field, cranial nerve function, and pituitary hormone deficits. Using logistic regression analysis, various factors were analyzed for their associations with recovery of neuroendocrine functions. The study included 98 patients. Multivariate analysis showed that older age and greater suprasellar extension were associated with no recovery of VA (P= 0.042 and P= 0.018, respectively). Only 33% of patients aged >55 years and suprasellar extension of lesion ≥25 mm gained recovery of VA, while 100% of patients with neither of these factors had recovery. Underlying hypertension was associated with no recovery of preoperative visual field defect (P= 0.027). Wilson-Hardy classification-invasion grades 3-4 and lower preoperative serum prolactin level were associated with no recovery from preoperative hypoadrenalism and hypothyroidism (P= 0.016 and P=0.007, respectively). Older age, higher suprasellar extension, and hypertension were poor prognostic factors for visual recovery. Wilson-Hardy inferior invasion grade 3-4 and lower preoperative serum prolactin level were poor prognostic factors for recovery from hypopituitarism. Stratifying patients according to these prognostic factors may assist in selecting patients for surgery.