Experience with Pituitary Apoplexy from India

Summary of the Article

1. Title of the Article

Pituitary apoplexy: a comprehensive analysis of 93 cases across functioning and non-functioning pituitary adenomas from a single-center

2. First Two Authors Followed by et al.

Divya C. Ragate, Manjiri Karlekar, et al.

3. One-line Summary of the Article

This study retrospectively analyzes 93 cases of pituitary apoplexy (PA) in both functioning and non-functioning pituitary adenomas, highlighting differences in presentation, management, and outcomes.

4. Six Key Points from the Article

1. Prevalence and Demographics: PA occurred in 4.76% of pituitary adenoma cases, with a higher prevalence in non-functioning adenomas (9%). The median age was 40 years, with a male predominance (60.2%).
2. Clinical Presentation: The most common symptoms were headache (78.5%) and visual disturbances (50.5%). PA was the first presentation in 98.4% of non-functioning adenomas and 74.2% of functioning adenomas.
3. Tumor Characteristics: Tumors in functioning adenomas were larger (3.2 cm vs. 2.3 cm in non-functioning adenomas). Prolactinomas and corticotropin-secreting adenomas were the most common functional subtypes.
4. Management Approaches: 46.2% of cases were managed conservatively, particularly prolactinomas, which responded well to cabergoline and steroids. Patients with Cushing’s disease and acromegaly required surgical intervention.
5. Outcomes: Recovery of neurological deficits was comparable between conservative and surgical management, with most requiring long-term hormone replacement. PAS (Pituitary Apoplexy Score) was useful in guiding treatment decisions.
6. Comparative Analysis: A PAS-matched cohort analysis showed no significant difference in neuro-hormonal recovery between surgical and conservative management, supporting a selective approach to surgery.

5. Practical Take-home Message

Pituitary apoplexy management should be individualized based on the Pituitary Apoplexy Score (PAS) and tumor functionality. Non-functioning adenomas with low PAS can be managed conservatively, while functioning tumors, particularly Cushing’s disease and acromegaly, often require definitive surgical treatment. Prolactinomas with apoplexy can be effectively treated with dopamine agonists.

6. Citation (Vancouver Format)

Ragate DC, Karlekar M, Memon SS, Barnabas R, Lila AR, Sarathi V, et al. Pituitary apoplexy: a comprehensive analysis of 93 cases across functioning and non-functioning pituitary adenomas from a single-center. Pituitary. 2024. https://doi.org/10.1007/s11102-024-01453-5