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08-06-2024

Pituitary apoplexy in cushing’s disease: a single center study and systematic literature review

Authors: Divya C Ragate, Saba Samad Memon, Vijaya Sarathi, Anurag Ranjan Lila, Chethan Yami Channaiah, Virendra A Patil, Manjiri Karlekar, Rohit Barnabas, Hemangini Thakkar, Nalini S Shah, Tushar R Bandgar

Published in: Pituitary

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Abstract

Introduction

Pituitary apoplexy (PA) in Cushing’s disease (CD) is rare with data limited to case reports/series.

Methods

We retrospectively reviewed case records of PA in CD managed at our center from 1987 to 2023 and performed a systematic literature review.

Results

We identified 58 patients (44 females), including twelve from our center (12/315 CD, yielding a PA prevalence in CD of 3.8%) and forty six from systematic review. The median age at PA diagnosis was 35 years. The most common presentation was type A (79.3%) and symptom was headache (89.6%), with a median Pituitary Apoplexy Score (PAS) of 2. Median cortisol and ACTH levels were 24.9 µg/dl and 94.1 pg/ml, respectively. Apoplexy was the first manifestation of underlying CD in 55.2% of cases, with 31.1% (14/45) presenting with hypocortisolemia (serum cortisol ≤ 5.0 µg/dl), underscoring the importance of recognizing clinical signs/symptoms of hypercortisolism. The median largest tumor dimension was 1.7 cm (53/58 were macroadenomas). PA was managed surgically in 57.8% of cases, with the remainder conservatively managed. All five PA cases in CD with microadenoma achieved remission through conservative management, though two later relapsed. Among treatment-naïve CD patients with macroadenoma, PA-related neuro-deficit improvement was comparable between surgical and conservative groups. However, a greater proportion of surgically managed patients remained in remission longer (70% vs. 38.5%; p = 0.07), for an average of 31 vs. 10.5 months.

Conclusion

PA in CD is more commonly associated with macroadenomas, may present with hypocortisolemia, and surgical treatment tends towards higher and longer-lasting remission rates.
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Metadata
Title
Pituitary apoplexy in cushing’s disease: a single center study and systematic literature review
Authors
Divya C Ragate
Saba Samad Memon
Vijaya Sarathi
Anurag Ranjan Lila
Chethan Yami Channaiah
Virendra A Patil
Manjiri Karlekar
Rohit Barnabas
Hemangini Thakkar
Nalini S Shah
Tushar R Bandgar
Publication date
08-06-2024
Publisher
Springer US
Published in
Pituitary
Print ISSN: 1386-341X
Electronic ISSN: 1573-7403
DOI
https://doi.org/10.1007/s11102-024-01411-1
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