期刊
ENDOCRINE
卷 71, 期 1, 页码 168-177出版社
SPRINGER
DOI: 10.1007/s12020-020-02499-8
关键词
Pituitary; Adenoma; Apoplexy; Conservative treatment; Surgery
The study compared the outcomes of patients with pituitary apoplexy managed by conservative or surgical approaches, finding no significant differences at 1 year in terms of visual field defects and visual acuity impairment. The Pituitary Apoplexy Score (PAS) may be a reliable parameter for guiding therapeutic strategy, with surgery recommended for patients with a PAS score >= 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.
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