MON-LB077 A Large Single Institution Series of Neuroendocrine Recovery and Tumor Recurrence after Pituitary Apoplexy

Abstract

Introduction: Pituitary apoplexy (PA) is a neurosurgical and endocrine emergency. Prompt recognition and treatment can significantly improve outcomes. Although there are several case series and retrospective reviews of patients with pituitary apoplexy, the vast majority of these include less than 50 patients. Furthermore, endocrine follow-up data is lacking from these studies. We aimed to retrospectively review recovery of neuroendocrine function in early vs. late surgery and to determine whether there was a lower incidence of recurrence of pituitary tumors after apoplexy. Methods: We reviewed the charts of 72 patients managed surgically for PA at our hospital between 1986 and 2018. We analyzed presentation patterns, imaging, and pathology findings, and pre and post-operative endocrine data. Patients were included in the study if they had surgical or pathologic confirmation of PA. There were no exclusion criteria. Early intervention was defined as within 8 days of presentation. Post-operative hormone replacement was evaluated by review of patients’ medications. Results: Of the 72 patients reviewed, data regarding early vs. late surgery was available for 69 patients. 47.8% (n=33) of patients received early intervention and 52.2% (n=36) received surgery 8 or more days after symptom onset. No association between timing of surgery and recovery of neuroendocrine function was observed. 51.5% (n=17) of patients who received early surgery vs. 52.8% (n=19) who received late surgery required post-operative steroid replacement (p= 0.92). 42.4% (n=14) vs. 40.0% (n=14) required post-operative thyroid replacement (p=0.84). 24.2% (n=8) vs. 17.1% (n=6) required post-operative testosterone replacement (p=0.47). 12.1% (n=4) vs. 8.8% (n=3) required post-operative DDAVP replacement (p=0.71). 17% (n=12) of our patients had tumors that recurred. Of these, 8 were non-functioning adenomas, 2 were Rathke cleft cysts, 1 was a prolactinoma, and 1 was a chordoma. 4 of our patients were lost to follow up. Neurological outcomes resolved in 45% (n=15) vs. 50% (n=18) of patients, and improved in 45% (n=15) vs. 33% (n=12) in the early vs late intervention group respectively. Conclusion: Whether to perform early surgery in patients with PA is a topic of debate. We report no significant difference in neuroendocrine outcomes of patients who were treated with early vs. late surgery. Our recurrence incidence after PA is consistent with that of non-functioning pituitary adenomas that do not undergo apoplexy, which is quoted to be about 16%. Future studies are needed to corroborate our findings. Unless otherwise noted, all abstracts presented at ENDO are embargoed until the date and time of presentation. For oral presentations, the abstracts are embargoed until the session begins. s presented at a news conference are embargoed until the date and time of the news conference. The Endocrine Society reserves the right to lift the embargo on specific abstracts that are selected for promotion prior to or during ENDO.