Clinical features and treatment outcomes of patients with pituitary apoplexy： a single-center retrospective study of 46 cases

Abstract:

Objective To investigate the clinical symptoms，endocrine and radiological features，clinical outcomes，and prognosis of patients with pituitary apoplexy.Methods A retrospective analysis was performed for the clinical data of 46 patients who were diagnosed with “pituitary apoplexy” in West China Hospital，Sichuan University，from January 1，2015 to December 31，2021，and the diagnosis of pituitary apoplexy was based on clinical，radiological，and histopathological reports. Clinical symptoms and signs，neuroimaging findings，pathological features，and endocrine results were summarized，and clinical outcome and prognosis were analyzed.Results A total of 46 patients with pituitary apoplexy were included，among whom there were 20 male patients（43.5%） with a mean age of 47.05（15.81） years and 26 female patients with a mean age of 31.96（14.78） years. Most patients had headache（n=38，82.6%） and varying degrees of hormone deficiency，among which pituitary-gonadal axis involvement was the most common type（n=28，60.9%），followed by pituitary-thyroid axis involvement in 21 patients（45.7%），pituitary-adrenal axis involvement in 19 patients（41.3%），GH/IGF-1 axis involvement in 5 patients（10.9%），and posterior pituitary involvement（diabetes insipidus） in 8 patients（17.4%）. All patients with pituitary apoplexy had characteristic changes on MRI，and some patients had the typical sign of liquefaction necrosis. Of all patients，9（19.6%） received antithrombotic therapy and 12 received surgical treatment，among whom 7 experienced the recurrence of pituitary adenoma during follow-up，while no patients died during the acute course of the disease. During follow-up for 5.2±1.9 years，most patients had hypopituitarism and received hormone replacement therapy.Conclusion Pituitary apoplexy is a critical neuroendocrine emergency，and early identification of symptoms and timely treatment，especially the correction of endocrine disorders，are of great importance for avoiding serious complications. Anterior hypopituitarism in pituitary apoplexy should be taken seriously by clinicians to avoid potential risks.