Abstract 58: Neuro-visual and endocrine outcomes in pituitary apoplexy: A retrospective single center experience

Background: Apoplexyasa presenting feature is seen in as high as 75% of pituitary adenomas.1The role of conservative management and trans-sphenoidalsurgery (TSS) for those with initial neuro-ophthalmologicsignsisdebatable.2A recent meta-analysis concluded that visual and endocrine recovery do not differ between these two modalities.2 Methodology: Design: Retrospectivestudy Studyduration: January 2000-July 2022 Inclusion criteria: Patients with clinical and radiologicalevidence of pituitary apoplexy among non-functioningpituitaryadenomas (NFPA). Exclusioncriteria: Histopathological evidence of hemorrhage/necrosis without a relevant clinical history. Apoplexy in functioning pituitary adenoma/other sellar-suprasellarmasses. Results: 31 patients (23 males and 8 females) with a median (range) age of 42 (23-71) years were included. Acute (£1 month) and subacute (>1 month) presentation were seen in 27 and 4 patients, respectively. 18 patients underwent TSS (Group A) within 7 days ofpresentation and 13 patients were managed conservatively (Group B). Visual, neuro-ophthalmologic, and hormonal outcomes ofgroup A and B were not different. Complete and partial hormone recovery was seen 2/12 and 1/12 patients in Group A; 2/11 and 1/11 patients in Group B, respectively. None of the patients who were managed conservatively required TSS on follow-up. Cranial nerve palsies improved in 100% (5/5) as opposed 50% (2/4) of patients with size £3 and >3 cm, respectively who underwent TSS. No other baseline demographic (age/sex/duration) or hormonal parameters determined neuro-visual and endocrine outcomes. Discussion: Similar neuro-visual and hormonal outcomes between conservative and surgical modalities of treatment is reported in meta-analysis by Goshtasbi et al.2 This is due to a selection bias wherein more severe patientswere subjected to surgery but observation as seen by the significantly larger tumor size and higher proportion of cranial nerve palsies in the former. The better neuro-visual recovery and sub-optimal hormonal recovery with conservative approach despite a milder disease to begin with, were similar to those observed by Singh et al. and Leyer et al.3,4 The pathophysiological explanation could be due to permanent damage anterior pituitary trophic cells. Nonetheless, lack of prospective RCT's makes decision making process subjective/at discretion of multidisciplinary team. Hence, milder cases or those with neuro-ophthalmologic signs and a tumor size £3 cm could be managed conservatively reserving surgery for larger (>3 cm) tumors; those with worsening neuro-ophthalmologic disease. Limitations: Retrospectivenatureofthestudy. Lackofcompletehormonedataatfollow-up.