Sumithra Giritharan1, Kanna Gnanalingham2,3, Tara Kearney1,3. 1. Department of Endocrinology, Salford Royal NHS Foundation Trust, Salford, Greater Manchester, UK. 2. Department of Neurosurgery, Salford Royal NHS Foundation Trust, Salford, Greater Manchester, UK. 3. Manchester Academic Health Sciences Centre, University of Manchester, Manchester, UK.
Abstract
OBJECTIVE: To describe the clinical presentation, management and outcome of pituitary apoplexy from a single centre and retrospectively apply the Pituitary Apoplexy Score (PAS). DESIGN: Retrospective review of patients presenting with classical pituitary apoplexy to a single neurosurgical centre in the Greater Manchester region. RESULTS: A total of 31 cases with classical pituitary apoplexy were identified between 2005 and 2014. The mean age at presentation was 55 years, and there were 19 men. In only one patient was there prior knowledge of a pituitary adenoma. Eleven (35%) patients were managed conservatively and 20 (65%) patients managed surgically. Emergency surgery was carried out in 11 patients. At presentation, visual symptoms were present in a higher proportion of patients in the surgical group (90%) compared to the conservatively managed group (64%). At final follow-up, visual recovery was apparent in most patients in both the surgical (100%) and conservatively (86%) managed groups. The proportion of patients with hypopituitarism was high in both the surgical (86%) and conservative (73%) groups at presentation, and this failed to improve at final follow-up (90% vs 73%, respectively). The median PAS scores were higher in the surgical (PAS 2), compared to the conservatively managed group (PAS 0). CONCLUSION: In pituitary apoplexy patients managed conservatively or surgically, there is good recovery of visual symptoms but not endocrine function. Patients should be managed on a case-by-case basis based on the severity of symptoms at presentation, progression of disease and surgical expertise available. Further prospective studies using the PAS are required to determine its usefulness in clinical practice.
OBJECTIVE: To describe the clinical presentation, management and outcome of pituitary apoplexy from a single centre and retrospectively apply the Pituitary Apoplexy Score (PAS). DESIGN: Retrospective review of patients presenting with classical pituitary apoplexy to a single neurosurgical centre in the Greater Manchester region. RESULTS: A total of 31 cases with classical pituitary apoplexy were identified between 2005 and 2014. The mean age at presentation was 55 years, and there were 19 men. In only one patient was there prior knowledge of a pituitary adenoma. Eleven (35%) patients were managed conservatively and 20 (65%) patients managed surgically. Emergency surgery was carried out in 11 patients. At presentation, visual symptoms were present in a higher proportion of patients in the surgical group (90%) compared to the conservatively managed group (64%). At final follow-up, visual recovery was apparent in most patients in both the surgical (100%) and conservatively (86%) managed groups. The proportion of patients with hypopituitarism was high in both the surgical (86%) and conservative (73%) groups at presentation, and this failed to improve at final follow-up (90% vs 73%, respectively). The median PAS scores were higher in the surgical (PAS 2), compared to the conservatively managed group (PAS 0). CONCLUSION: In pituitary apoplexy patients managed conservatively or surgically, there is good recovery of visual symptoms but not endocrine function. Patients should be managed on a case-by-case basis based on the severity of symptoms at presentation, progression of disease and surgical expertise available. Further prospective studies using the PAS are required to determine its usefulness in clinical practice.
Authors: Mohammed Alahmari; Fahad Alkherayf; Andrea Lasso; Fatmahalzahra Banaz; Sepideh Mohajeri; Pourya Masoudian; Andre Lamothe; Charles Agbi; Lisa Caulley; Mohammad Alshardan; Shaun Kilty Journal: J Neurol Surg B Skull Base Date: 2021-01-21
Authors: Patrick D Kelly; Shanik J Fernando; Jordan A Malenke; Rakesh K Chandra; Justin H Turner; Lola B Chambless Journal: J Neurol Surg B Skull Base Date: 2020-01-24
Authors: Ali Abbara; Sophie Clarke; Pei Chia Eng; James Milburn; Devavrata Joshi; Alexander N Comninos; Rozana Ramli; Amrish Mehta; Brynmor Jones; Florian Wernig; Ramesh Nair; Nigel Mendoza; Amir H Sam; Emma Hatfield; Karim Meeran; Waljit Singh Dhillo; Niamh M Martin Journal: Endocr Connect Date: 2018-08-23 Impact factor: 3.335