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Natural history of pituitary apoplexy: a long-term follow-up study

Authors :
Ayesha A Shaikh
David Michael Williams
Jeffrey Wayne Stephens
Kusuma Boregowda
Maneesh Vasanth Udiawar
David E Price
Source :
Postgraduate Medical Journal. :postgradmedj-2022
Publication Year :
2022
Publisher :
Oxford University Press (OUP), 2022.

Abstract

Background and aimsPituitary apoplexy (PA) is a rare neurosurgical emergency, associated with deficiency of one or more pituitary hormones. Few studies have explored the relative outcomes associated with conservative and neurosurgical intervention.MethodsA retrospective evaluation of all patients with PA reviewed at Morriston Hospital was undertaken and diagnosis was obtained from Morriston database (Leicester Clinical Workstation database) between 1998 and 2019 from clinic letters and discharge summaries.ResultsThirty-nine patients with PA were identified with a mean age of 74.5 years and 20 (51.3%) patients were women. Patients were followed up for a mean±SD 68.1±61.7 months. Twenty-three (59.0%) patients had a known pituitary adenoma. Commoner clinical presentations of PA were ophthalmoplegia or visual field loss. Following PA, 34 (87.2%) patients were noted to have a non-functioning pituitary adenoma (either pre-existing or new), while 5 (12.8%) patients had a pre-existing functional macroadenoma. Neurosurgical intervention was taken in 15 (38.5%) patients of which 3 (20.0%) patients also received radiotherapy, 2 (13.3%) patients had radiotherapy alone and the remainder managed conservatively. External ophthalmoplegia recovered in all cases. Visual loss remained in all cases. One (2.6%) patient with chromophobe adenoma had a significant second episode of PA requiring repeat surgery.ConclusionPA often occurs in patients with undiagnosed adenoma. Hypopituitarism commonly occurred following conservative or surgical treatment. External ophthalmoplegia resolved in all cases, however, visual loss did not recover. Pituitary tumour recurrence and further PA episodes are rare.

Subjects

Subjects :
General Medicine

Details

ISSN :
14690756 and 00325473
Database :
OpenAIRE
Journal :
Postgraduate Medical Journal
Accession number :
edsair.doi.dedup.....9258d39f2cf1bf5a2e91f1c7aaedbb98
Full Text :
https://doi.org/10.1136/postgradmedj-2022-141836