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08-06-2024 | Pituitary Apoplexy | Original Article

Exploring risk factors of severe pituitary apoplexy: Insights from a multicenter study of 71 cases

Authors: Pablo Garcia-Feijoo, Carlos Perez Lopez, Igor Paredes, Alberto Acitores Cancela, Cristina Alvarez-Escola, Maria Calatayud, Alfonso Lagares, Maria Soledad Librizzi, Victor Rodriguez Berrocal, Marta Araujo-Castro

Published in: Endocrine

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Abstract

Purpose

To identify clinical and radiological factors associated with a higher risk of developing a severe pituitary apoplexy (PA).

Methods

Multicenter retrospective study of patients presenting with clinical PA in three Spanish tertiary hospitals of Madrid between 2008 and 2022. We classified PA as severe when presenting with an altered level of consciousness (Glasgow Coma Scale (GCS) < 15) or visual involvement.

Results

A total of 71 PA cases were identified, of whom 80.28% (n = 57) were classified as severe PA. The median age was 60 (18 to 85 years old) and 67.6% (n = 48) were male. Most patients had macroadenomas, except for one patient with a microadenoma of 9 mm. Headache was the most common presenting symptom (90.1%) and anticoagulation was the most frequent predisposing risk factor, but it was not associated with a higher risk for severe PA (odds ratio [OR] 1.13 [0.21–5.90]). Severe cases were associated with male gender (OR 5.53 [1.59–19.27]), tumor size >20 mm (OR 17.67 [4.07–76.64]), and Knosp grade ≥2 (OR 9.6 [2.38–38.73]). In the multivariant analysis, the only variables associated with a higher risk for severe PA were tumor size and Knosp grade. Surgery was more common in severe PA than in non-severe (91.2% vs. 64.3%, P = 0.009).

Conclusion

A tumor size >20 mm and cavernous sinus invasion are risk factors for developing a severe PA. These risk factors can stratify patients at a higher risk of a worse clinical picture, and subsequently, more need of decompressive surgery.
Literature
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go back to reference D.D. Hickstein, W.F. Chandler, J.C. Marshall, A. Arbor, The spectrum of pituitary Adenoma Hemorrhage. West J Med 144(4), 433–436 (1986)PubMedPubMedCentral D.D. Hickstein, W.F. Chandler, J.C. Marshall, A. Arbor, The spectrum of pituitary Adenoma Hemorrhage. West J Med 144(4), 433–436 (1986)PubMedPubMedCentral
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Metadata
Title
Exploring risk factors of severe pituitary apoplexy: Insights from a multicenter study of 71 cases
Authors
Pablo Garcia-Feijoo
Carlos Perez Lopez
Igor Paredes
Alberto Acitores Cancela
Cristina Alvarez-Escola
Maria Calatayud
Alfonso Lagares
Maria Soledad Librizzi
Victor Rodriguez Berrocal
Marta Araujo-Castro
Publication date
08-06-2024
Publisher
Springer US
Published in
Endocrine
Print ISSN: 1355-008X
Electronic ISSN: 1559-0100
DOI
https://doi.org/10.1007/s12020-024-03918-w
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