Pituitary Apoplexy: Results of Surgical and Conservative Management Clinical Series and Review of the Literature

Joao Paulo Almeida, Miguel Marigil Sanchez, Claire Karekezi, Nebras Warsi, Rodrigo Fernández-Gajardo, Jyoti Panwar, Alireza Mansouri, Suganth Suppiah, Farshad Nassiri, Romina Nejad, Walter Kucharczyk, Rowena Ridout, Andrei F. Joaquim, Fred Gentili, Gelareh Zadeh

Research output: Contribution to journalArticle

Abstract

Objective: Pituitary apoplexy is associated with visual, cranial nerve, and endocrine dysfunction. In this article, the results of surgical and conservative management of pituitary apoplexy in a single center are evaluated and a review of the literature is presented. Methods: A retrospective analysis was made of patients with pituitary apoplexy who underwent surgery or conservative management at our center between January 2007 and June 2017. Surgery was typically selected for patients who presented with acute deterioration of visual status and/or level of consciousness. Patients with no visual field deficit and those who had medical contraindications to undergo a surgical procedure because of previous comorbidities typically had conservative treatment. Baseline characteristics and clinical and radiologic outcomes were reviewed. A review of the literature (1990–2018) was performed according to PRISMA guidelines. Studies comparing the results of conservative and surgical management were identified. Visual, cranial nerve, and endocrine outcomes and tumor recurrence were analyzed. Results: Forty-nine patients (73.1%) were managed surgically and 18 (26.9%) conservatively. After careful case selection, patients underwent surgical or conservative treatment. Patients who underwent conservative treatment had fewer visual deficits. At diagnosis, visual deficit (38.8% vs. 75.5%; P = 0.008) and cranial nerve palsy (27.7% vs. 51%; P = 0.058) were less common in the conservative group. Conservative and surgical treatments had similar visual and cranial nerve improvement rates (75% vs. 58.3%, P = 0.63 and 75% vs. 69.2%, P = 1.0, respectively). In the conservative group, tumor shrinkage was observed in 76.4% of cases. The systematic review retrieved 11 studies. No significant difference between conservative and surgical treatment for clinical outcomes (visual field recovery, odds ratio [OR], 1.45; 95% confidence interval [CI], 0.72–2.92; cranial nerve recovery, OR, 2.30; 95% CI, 0.93–5.65; and hypopituitarism, OR, 1.05; 95% CI, 0.64–1.74) or tumor recurrence (OR, 0.68; 95% CI, 0.20–2.34) was observed. Conclusions: A tailored approach to pituitary apoplexy, one that does not include an absolute need for surgery, is appropriate. Conservative management is appropriate in selected patients presenting without visual deficits.

Original languageEnglish (US)
Pages (from-to)e988-e999
JournalWorld neurosurgery
Volume130
DOIs
StatePublished - Oct 2019

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Pituitary Apoplexy
Cranial Nerves
Odds Ratio
Confidence Intervals
Visual Fields
Conservative Treatment
Cranial Nerve Diseases
Recurrence
Neoplasms
Hypopituitarism
Consciousness
Patient Selection
Comorbidity
Guidelines

All Science Journal Classification (ASJC) codes

  • Surgery
  • Clinical Neurology

Cite this

Almeida, J. P., Sanchez, M. M., Karekezi, C., Warsi, N., Fernández-Gajardo, R., Panwar, J., ... Zadeh, G. (2019). Pituitary Apoplexy: Results of Surgical and Conservative Management Clinical Series and Review of the Literature. World neurosurgery, 130, e988-e999. https://doi.org/10.1016/j.wneu.2019.07.055
Almeida, Joao Paulo ; Sanchez, Miguel Marigil ; Karekezi, Claire ; Warsi, Nebras ; Fernández-Gajardo, Rodrigo ; Panwar, Jyoti ; Mansouri, Alireza ; Suppiah, Suganth ; Nassiri, Farshad ; Nejad, Romina ; Kucharczyk, Walter ; Ridout, Rowena ; Joaquim, Andrei F. ; Gentili, Fred ; Zadeh, Gelareh. / Pituitary Apoplexy : Results of Surgical and Conservative Management Clinical Series and Review of the Literature. In: World neurosurgery. 2019 ; Vol. 130. pp. e988-e999.
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abstract = "Objective: Pituitary apoplexy is associated with visual, cranial nerve, and endocrine dysfunction. In this article, the results of surgical and conservative management of pituitary apoplexy in a single center are evaluated and a review of the literature is presented. Methods: A retrospective analysis was made of patients with pituitary apoplexy who underwent surgery or conservative management at our center between January 2007 and June 2017. Surgery was typically selected for patients who presented with acute deterioration of visual status and/or level of consciousness. Patients with no visual field deficit and those who had medical contraindications to undergo a surgical procedure because of previous comorbidities typically had conservative treatment. Baseline characteristics and clinical and radiologic outcomes were reviewed. A review of the literature (1990–2018) was performed according to PRISMA guidelines. Studies comparing the results of conservative and surgical management were identified. Visual, cranial nerve, and endocrine outcomes and tumor recurrence were analyzed. Results: Forty-nine patients (73.1{\%}) were managed surgically and 18 (26.9{\%}) conservatively. After careful case selection, patients underwent surgical or conservative treatment. Patients who underwent conservative treatment had fewer visual deficits. At diagnosis, visual deficit (38.8{\%} vs. 75.5{\%}; P = 0.008) and cranial nerve palsy (27.7{\%} vs. 51{\%}; P = 0.058) were less common in the conservative group. Conservative and surgical treatments had similar visual and cranial nerve improvement rates (75{\%} vs. 58.3{\%}, P = 0.63 and 75{\%} vs. 69.2{\%}, P = 1.0, respectively). In the conservative group, tumor shrinkage was observed in 76.4{\%} of cases. The systematic review retrieved 11 studies. No significant difference between conservative and surgical treatment for clinical outcomes (visual field recovery, odds ratio [OR], 1.45; 95{\%} confidence interval [CI], 0.72–2.92; cranial nerve recovery, OR, 2.30; 95{\%} CI, 0.93–5.65; and hypopituitarism, OR, 1.05; 95{\%} CI, 0.64–1.74) or tumor recurrence (OR, 0.68; 95{\%} CI, 0.20–2.34) was observed. Conclusions: A tailored approach to pituitary apoplexy, one that does not include an absolute need for surgery, is appropriate. Conservative management is appropriate in selected patients presenting without visual deficits.",
author = "Almeida, {Joao Paulo} and Sanchez, {Miguel Marigil} and Claire Karekezi and Nebras Warsi and Rodrigo Fern{\'a}ndez-Gajardo and Jyoti Panwar and Alireza Mansouri and Suganth Suppiah and Farshad Nassiri and Romina Nejad and Walter Kucharczyk and Rowena Ridout and Joaquim, {Andrei F.} and Fred Gentili and Gelareh Zadeh",
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volume = "130",
pages = "e988--e999",
journal = "World Neurosurgery",
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Almeida, JP, Sanchez, MM, Karekezi, C, Warsi, N, Fernández-Gajardo, R, Panwar, J, Mansouri, A, Suppiah, S, Nassiri, F, Nejad, R, Kucharczyk, W, Ridout, R, Joaquim, AF, Gentili, F & Zadeh, G 2019, 'Pituitary Apoplexy: Results of Surgical and Conservative Management Clinical Series and Review of the Literature', World neurosurgery, vol. 130, pp. e988-e999. https://doi.org/10.1016/j.wneu.2019.07.055

Pituitary Apoplexy : Results of Surgical and Conservative Management Clinical Series and Review of the Literature. / Almeida, Joao Paulo; Sanchez, Miguel Marigil; Karekezi, Claire; Warsi, Nebras; Fernández-Gajardo, Rodrigo; Panwar, Jyoti; Mansouri, Alireza; Suppiah, Suganth; Nassiri, Farshad; Nejad, Romina; Kucharczyk, Walter; Ridout, Rowena; Joaquim, Andrei F.; Gentili, Fred; Zadeh, Gelareh.

In: World neurosurgery, Vol. 130, 10.2019, p. e988-e999.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Pituitary Apoplexy

T2 - Results of Surgical and Conservative Management Clinical Series and Review of the Literature

AU - Almeida, Joao Paulo

AU - Sanchez, Miguel Marigil

AU - Karekezi, Claire

AU - Warsi, Nebras

AU - Fernández-Gajardo, Rodrigo

AU - Panwar, Jyoti

AU - Mansouri, Alireza

AU - Suppiah, Suganth

AU - Nassiri, Farshad

AU - Nejad, Romina

AU - Kucharczyk, Walter

AU - Ridout, Rowena

AU - Joaquim, Andrei F.

AU - Gentili, Fred

AU - Zadeh, Gelareh

PY - 2019/10

Y1 - 2019/10

N2 - Objective: Pituitary apoplexy is associated with visual, cranial nerve, and endocrine dysfunction. In this article, the results of surgical and conservative management of pituitary apoplexy in a single center are evaluated and a review of the literature is presented. Methods: A retrospective analysis was made of patients with pituitary apoplexy who underwent surgery or conservative management at our center between January 2007 and June 2017. Surgery was typically selected for patients who presented with acute deterioration of visual status and/or level of consciousness. Patients with no visual field deficit and those who had medical contraindications to undergo a surgical procedure because of previous comorbidities typically had conservative treatment. Baseline characteristics and clinical and radiologic outcomes were reviewed. A review of the literature (1990–2018) was performed according to PRISMA guidelines. Studies comparing the results of conservative and surgical management were identified. Visual, cranial nerve, and endocrine outcomes and tumor recurrence were analyzed. Results: Forty-nine patients (73.1%) were managed surgically and 18 (26.9%) conservatively. After careful case selection, patients underwent surgical or conservative treatment. Patients who underwent conservative treatment had fewer visual deficits. At diagnosis, visual deficit (38.8% vs. 75.5%; P = 0.008) and cranial nerve palsy (27.7% vs. 51%; P = 0.058) were less common in the conservative group. Conservative and surgical treatments had similar visual and cranial nerve improvement rates (75% vs. 58.3%, P = 0.63 and 75% vs. 69.2%, P = 1.0, respectively). In the conservative group, tumor shrinkage was observed in 76.4% of cases. The systematic review retrieved 11 studies. No significant difference between conservative and surgical treatment for clinical outcomes (visual field recovery, odds ratio [OR], 1.45; 95% confidence interval [CI], 0.72–2.92; cranial nerve recovery, OR, 2.30; 95% CI, 0.93–5.65; and hypopituitarism, OR, 1.05; 95% CI, 0.64–1.74) or tumor recurrence (OR, 0.68; 95% CI, 0.20–2.34) was observed. Conclusions: A tailored approach to pituitary apoplexy, one that does not include an absolute need for surgery, is appropriate. Conservative management is appropriate in selected patients presenting without visual deficits.

AB - Objective: Pituitary apoplexy is associated with visual, cranial nerve, and endocrine dysfunction. In this article, the results of surgical and conservative management of pituitary apoplexy in a single center are evaluated and a review of the literature is presented. Methods: A retrospective analysis was made of patients with pituitary apoplexy who underwent surgery or conservative management at our center between January 2007 and June 2017. Surgery was typically selected for patients who presented with acute deterioration of visual status and/or level of consciousness. Patients with no visual field deficit and those who had medical contraindications to undergo a surgical procedure because of previous comorbidities typically had conservative treatment. Baseline characteristics and clinical and radiologic outcomes were reviewed. A review of the literature (1990–2018) was performed according to PRISMA guidelines. Studies comparing the results of conservative and surgical management were identified. Visual, cranial nerve, and endocrine outcomes and tumor recurrence were analyzed. Results: Forty-nine patients (73.1%) were managed surgically and 18 (26.9%) conservatively. After careful case selection, patients underwent surgical or conservative treatment. Patients who underwent conservative treatment had fewer visual deficits. At diagnosis, visual deficit (38.8% vs. 75.5%; P = 0.008) and cranial nerve palsy (27.7% vs. 51%; P = 0.058) were less common in the conservative group. Conservative and surgical treatments had similar visual and cranial nerve improvement rates (75% vs. 58.3%, P = 0.63 and 75% vs. 69.2%, P = 1.0, respectively). In the conservative group, tumor shrinkage was observed in 76.4% of cases. The systematic review retrieved 11 studies. No significant difference between conservative and surgical treatment for clinical outcomes (visual field recovery, odds ratio [OR], 1.45; 95% confidence interval [CI], 0.72–2.92; cranial nerve recovery, OR, 2.30; 95% CI, 0.93–5.65; and hypopituitarism, OR, 1.05; 95% CI, 0.64–1.74) or tumor recurrence (OR, 0.68; 95% CI, 0.20–2.34) was observed. Conclusions: A tailored approach to pituitary apoplexy, one that does not include an absolute need for surgery, is appropriate. Conservative management is appropriate in selected patients presenting without visual deficits.

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