Claire Marx1,2, Muriel Rabilloud3,4, Françoise Borson Chazot5,3, Caroline Tilikete3,6,7, Emmanuel Jouanneau3,8,9, Gerald Raverot5,3,9. 1. Hospices Civils de Lyon, Endocrinology Department, Reference Center for Rare Pituitary Diseases HYPO, 59 Pinel Boulevard, 69677, Bron, France. claire.marx@chu-lyon.fr. 2. Lyon I University, F-69373, Lyon, France. claire.marx@chu-lyon.fr. 3. Lyon I University, F-69373, Lyon, France. 4. I.f.c.s Hospices Civils de Lyon, 162 avenue Lacassagne, 75003, Lyon, France. 5. Hospices Civils de Lyon, Endocrinology Department, Reference Center for Rare Pituitary Diseases HYPO, 59 Pinel Boulevard, 69677, Bron, France. 6. "Groupement Hospitalier Est" Hospices Civils de Lyon, Neuro-ophthalmology and Neuro-cognitive Unit, 69677, Bron, France. 7. CRNL INSERM U1028 CNRS UMR5292, ImpAct Team, F-69676, Bron, France. 8. Neurosurgery Department, "Groupement Hospitalier Est" Hospices Civils de Lyon, 69677, Bron, France. 9. INSERM U1052, CNRS, UMR5286, Cancer Research Center of Lyon, 69372, Lyon, France.
Abstract
PURPOSE: The management of pituitary apoplexy, a rare emergency neuroendocrine condition, is controversial. The aim of the present study is to compare the outcomes of patients with pituitary apoplexy managed either by a conservative or surgical approach. METHODS: A retrospective cohort study including patients diagnosed between 2007 and 2018 in a tertiary French university hospital. Pituitary Apoplexy Score (PAS) was retrospectively applied in the perspective of therapeutic decision support. RESULTS: Forty-six patients were treated for pituitary apoplexy either with conservative management (n = 27) or surgery (n = 19). At initial evaluation, visual field defects (VFD) and visual acuity impairment were more frequent in patients from the surgery group. At 1 year there were no statistical differences in the rates of complete/near-complete resolution of VFD (100 vs. 91.7%), visual acuity impairment (100 vs. 87.5%), and cranial nerve palsies (83.3 vs. 100%), between conservative and surgical treatment groups. There were more endocrine deficits at 1 year in the surgical group (p = 0.029). PAS (n = 41) was 3.4 on average in the early surgery group and 1.3 in the conservative treatment/delayed surgery group. Among patients with a score < 4, 31.3% were operated at first line and did not present better outcomes than patients managed conservatively. In all, 88.9% of patients with a score ≥ 4 underwent surgery. CONCLUSIONS: PAS may be a reliable parameter for defining therapeutic strategy. Patients with non-severe and nonprogressive neuro-ophthalmological deficits can be managed conservatively without negative impact on outcomes, thus surgery should be reserved only for those patients with a PAS ≥ 4.
PURPOSE: The management of pituitary apoplexy, a rare emergency neuroendocrine condition, is controversial. The aim of the present study is to compare the outcomes of patients with pituitary apoplexy managed either by a conservative or surgical approach. METHODS: A retrospective cohort study including patients diagnosed between 2007 and 2018 in a tertiary French university hospital. Pituitary Apoplexy Score (PAS) was retrospectively applied in the perspective of therapeutic decision support. RESULTS: Forty-six patients were treated for pituitary apoplexy either with conservative management (n = 27) or surgery (n = 19). At initial evaluation, visual field defects (VFD) and visual acuity impairment were more frequent in patients from the surgery group. At 1 year there were no statistical differences in the rates of complete/near-complete resolution of VFD (100 vs. 91.7%), visual acuity impairment (100 vs. 87.5%), and cranial nerve palsies (83.3 vs. 100%), between conservative and surgical treatment groups. There were more endocrine deficits at 1 year in the surgical group (p = 0.029). PAS (n = 41) was 3.4 on average in the early surgery group and 1.3 in the conservative treatment/delayed surgery group. Among patients with a score < 4, 31.3% were operated at first line and did not present better outcomes than patients managed conservatively. In all, 88.9% of patients with a score ≥ 4 underwent surgery. CONCLUSIONS: PAS may be a reliable parameter for defining therapeutic strategy. Patients with non-severe and nonprogressive neuro-ophthalmological deficits can be managed conservatively without negative impact on outcomes, thus surgery should be reserved only for those patients with a PAS ≥ 4.
Entities:
Keywords:
Adenoma; Apoplexy; Conservative treatment; Pituitary; Surgery
Authors: C Leyer; F Castinetti; I Morange; M Gueydan; C Oliver; B Conte-Devolx; H Dufour; T Brue Journal: J Endocrinol Invest Date: 2010-08-31 Impact factor: 4.256
Authors: D C Bills; F B Meyer; E R Laws; D H Davis; M J Ebersold; B W Scheithauer; D M Ilstrup; C F Abboud Journal: Neurosurgery Date: 1993-10 Impact factor: 4.654