A key role for conservative treatment in the management of pituitary apoplexy
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ORIGINAL ARTICLE
A key role for conservative treatment in the management of pituitary apoplexy Claire Marx 1,2 Muriel Rabilloud2,3 Françoise Borson Chazot1,2 Caroline Tilikete2,4,5 Emmanuel Jouanneau2,6,7 Gerald Raverot1,2,7 ●
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Received: 17 May 2020 / Accepted: 11 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract 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. Keywords Pituitary Adenoma Apoplexy Conservative treatment Surgery ●
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Introduction Pituitary apoplexy is a clinical syndrome following an acute hemorrhage and/or infarction of a pituitary adenoma. Its
Supplementary information The online version of this article (https:// doi.org/10.1007/s12020-020-02499-8) contains supplementary material, which is available to authorized users. * Claire Marx [email protected] 1
Hospices Civils de Lyon, Endocrinology Department, Reference Center for Rare Pituitary Diseases HYPO, 59 Pinel Boulevard, 69677 Bron, France
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Lyon I University, F-69373 Lyon, France
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I.f.c.s Hospices Civils de Lyon, 162 avenue Lacassagne, 75003 Lyon, France
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prevalence is about 6.2 cases per 100,000 population [1] and affects 2–12% of all types of pituitary adenoma [1]. It is a potentially fatal condition that manifests with the sudden onset of severe headaches associated, in a variable proportion of cases, with
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