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Purpose <p>This nationwide, multicenter, retrospective cohort study aimed to evaluate long-term outcomes in patients with acute pituitary apoplexy (PA), focusing on pituitary function, neuro-ophthalmologic sequelae, and mortality.</p> Methods <p>Two hundred twenty adult patients diagnosed with acute PA between 2010 and 2023 across 15 Spanish tertiary centers were included. Patients were classified by management strategy: early surgery (≤ 7 days), delayed surgery (8–30 days), elective surgery (&gt; 30 days), or conservative management. Outcomes were analyzed using regression models adjusted for relevant covariates.</p> Results <p>At baseline, 68.2% were male, with a median age of 60.4 years. The most frequent symptoms included headache (94.1%), vomiting (61.8%), visual defects (43.6%), and cranial nerve palsies (51.4%). Median follow-up was 67.8 months. At the end of follow-up, hypopituitarism was present in 73.2% of patients (with TSH deficiency in 60.9%, gonadotropin deficiency in 57.3%, and ACTH deficiency in 58.2%). Persistent visual impairment occurred in 15.5%. The type of surgical approach did not significantly affect rates of hypopituitarism or visual impairment. Early and delayed surgery were associated with greater odds ratio of remission compared to conservative treatment. Twenty-five patients (11.4%) died during follow-up, with only one death directly attributed to PA.</p> Conclusion <p>Acute PA is associated with high rates of chronic pituitary deficiencies and neuro-ophthalmologic sequelae. Surgical timing did not influence endocrine or visual outcomes but may improve remission likelihood. No significant relationship was identified between mortality and PA or its management.</p>

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Pituitary apoplexy: long-term endocrine and neuro-ophthalmologic outcomes according to management strategy and timing

  • 期刊论文

  • 发表日期：

    2026年3月10日

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  • Fernando Guerrero-Pérez,
  • Betina Biagetti,
  • Marta Araujo-Castro,
  • Almudena Vicente,
  • Guillermo Serra,
  • Natalia Vega Rojas,
  • Inmaculada González Molero,
  • Rocío Villar-Taibo,
  • María Dolores Moure Rodríguez,
  • Edelmiro Luis Menéndez-Torre,
  • Cristina Lamas,
  • Marta Gallach,
  • M Dolores Ollero García,
  • Ana Irigaray,
  • Andreu Simó-Servat,
  • Eva Safont,
  • Queralt Asla,
  • Soralla Civantos,
  • Pedro Iglesias

摘要

Purpose

This nationwide, multicenter, retrospective cohort study aimed to evaluate long-term outcomes in patients with acute pituitary apoplexy (PA), focusing on pituitary function, neuro-ophthalmologic sequelae, and mortality.

Methods

Two hundred twenty adult patients diagnosed with acute PA between 2010 and 2023 across 15 Spanish tertiary centers were included. Patients were classified by management strategy: early surgery (≤ 7 days), delayed surgery (8–30 days), elective surgery (> 30 days), or conservative management. Outcomes were analyzed using regression models adjusted for relevant covariates.

Results

At baseline, 68.2% were male, with a median age of 60.4 years. The most frequent symptoms included headache (94.1%), vomiting (61.8%), visual defects (43.6%), and cranial nerve palsies (51.4%). Median follow-up was 67.8 months. At the end of follow-up, hypopituitarism was present in 73.2% of patients (with TSH deficiency in 60.9%, gonadotropin deficiency in 57.3%, and ACTH deficiency in 58.2%). Persistent visual impairment occurred in 15.5%. The type of surgical approach did not significantly affect rates of hypopituitarism or visual impairment. Early and delayed surgery were associated with greater odds ratio of remission compared to conservative treatment. Twenty-five patients (11.4%) died during follow-up, with only one death directly attributed to PA.

Conclusion

Acute PA is associated with high rates of chronic pituitary deficiencies and neuro-ophthalmologic sequelae. Surgical timing did not influence endocrine or visual outcomes but may improve remission likelihood. No significant relationship was identified between mortality and PA or its management.