Surgery For Pituitary Apoplexy Research Articles

Factors Predicting Neuroendocrine Recovery Following Transsphenoidal Surgery in Pituitary Apoplexy Patients

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.

Abstract #482 Differences in Post-Operative Complications After Transsphenoidal Surgery for Pituitary Apoplexy: A Nationwide Study

Abstract #482 Differences in Post-Operative Complications After Transsphenoidal Surgery for Pituitary Apoplexy: A Nationwide Study

Corrigendum to "In Reply to the Letter to the Editor Regarding "Endoscopic Endonasal Surgery for Pituitary Apoplexy: Evidence On a 75 Case-Series From a Tertiary Care Center"" [World Neurosurgery 109 (2018) 502

Corrigendum to "In Reply to the Letter to the Editor Regarding "Endoscopic Endonasal Surgery for Pituitary Apoplexy: Evidence On a 75 Case-Series From a Tertiary Care Center"" [World Neurosurgery 109 (2018) 502

A conservative management is preferable in milder forms of pituitary tumor apoplexy.

Our objective was to report a single-center experience of the management of pituitary tumor apoplexy. We retrospectively analyzed a series of 44 patients hospitalized for pituitary apoplexy between January 1996 and March 2008 at the Timone Hospital, Marseille, France. Most frequent presenting symptoms were headaches (93%), visual impairment (85%) and vomiting (59%). Hypopituitarism was present at diagnosis in 88% of patients, with a high incidence of corticotroph deficiency (70%). A risk factor was found in 52% of patients, mostly hypertension. Apoplexy occurred in a previously undiagnosed pituitary adenoma in 32/44 cases (73%). The apoplectic event concerned 12 secreting, 27 non-functioning, 4 uncharacterized adenomas and one Rathke's pouch cyst. Nineteen patients underwent surgery within the first month, and one patient had conventional radiotherapy. Twenty-four patients, who had no ophthalmic or neurological signs, were conservatively treated in first intention; among them, 6 received high dose corticosteroids. After a median follow-up of 21 months, there was no significant difference in terms of endocrine or visual recovery between the operated and the conservatively treated groups, nor between patients treated with corticosteroids or not. Panhypopituitarism was observed in 52% of patients, but partial or complete visual recovery was present in the majority of patients (91%), whatever the therapeutic approach. The outcome of patients treated with or without surgery for pituitary apoplexy without severe neuro-ophthalmic deficits seems to be identical, pleading for a conservative management of pituitary apoplexy in the absence of visual emergency.