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Rates of tumour control after conservative management of pituitary apoplexy
EANS Academy. Khawari S. 09/26/19; 276169; EP04063
Sogha Khawari
Sogha Khawari

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Abstract
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Introduction: Pituitary apoplexy is considered a neurosurgical emergency and surgical treatment is warranted to prevent visual deterioration. However, in patients with stable visual symptoms conservative management can be considered. We aim to assess the rates of long term tumour control, visual and biochemical outcomes in patients with pituitary apoplexy managed conservatively.
Methods: Fifty patients with pituitary apoplexy were reviewed. Patients with minor apoplexy or apoplexy in lesions confined to sella were excluded. Generally, patients with progressive or severe visual symptoms underwent surgery, while conservative management was preferred if symptoms were stable. Tumour growth was analysed and need for further surgery or radiotherapy was reviewed. The operative and non-operative groups were compared for visual and biochemical outcomes.
Results: 37 patients were treated surgically and 13 conservatively. Follow up ranged from 1-14 years (mean 6.9). More patients in the surgical cohort presented with a visual field defect (n=23 (62%) vs. n=2 (15%)) and visual acuity deterioration (n=19 (51%) vs. n=1 (7%)) but not ophthalmoplaegia (n=18 (48%) vs. n=7 (54%)). Hypopituitarism was present in 28/37 (76%) vs. 12/13 (92%) in the surgical and conservative groups respectively. Complete recovery of visual fields was seen in 14/22 (64%) vs. 2/2 (100%); complete recovery of visual acuity was seen in 10/19 (52%) vs. 1/1 (100%); complete recovery of ophthalmoplaegia was seen in 13/18 (72%) vs. 6/7 (86%) in the surgical and conservative groups respectively. Tumour progression was seen in 3/13 (23%) and 5/37 (14%) in conservative and surgically treated groups respectively. Two patients required further surgery in the conservative and surgical groups.
Conclusion: In select patients with pituitary apoplexy good visual symptoms can be achieved with conservative management. Long term tumour control was seen in three quarters of patients who did not undergo surgery, suggesting apoplexy may lead to complete tumour necrosis in majority of cases.
Introduction: Pituitary apoplexy is considered a neurosurgical emergency and surgical treatment is warranted to prevent visual deterioration. However, in patients with stable visual symptoms conservative management can be considered. We aim to assess the rates of long term tumour control, visual and biochemical outcomes in patients with pituitary apoplexy managed conservatively.
Methods: Fifty patients with pituitary apoplexy were reviewed. Patients with minor apoplexy or apoplexy in lesions confined to sella were excluded. Generally, patients with progressive or severe visual symptoms underwent surgery, while conservative management was preferred if symptoms were stable. Tumour growth was analysed and need for further surgery or radiotherapy was reviewed. The operative and non-operative groups were compared for visual and biochemical outcomes.
Results: 37 patients were treated surgically and 13 conservatively. Follow up ranged from 1-14 years (mean 6.9). More patients in the surgical cohort presented with a visual field defect (n=23 (62%) vs. n=2 (15%)) and visual acuity deterioration (n=19 (51%) vs. n=1 (7%)) but not ophthalmoplaegia (n=18 (48%) vs. n=7 (54%)). Hypopituitarism was present in 28/37 (76%) vs. 12/13 (92%) in the surgical and conservative groups respectively. Complete recovery of visual fields was seen in 14/22 (64%) vs. 2/2 (100%); complete recovery of visual acuity was seen in 10/19 (52%) vs. 1/1 (100%); complete recovery of ophthalmoplaegia was seen in 13/18 (72%) vs. 6/7 (86%) in the surgical and conservative groups respectively. Tumour progression was seen in 3/13 (23%) and 5/37 (14%) in conservative and surgically treated groups respectively. Two patients required further surgery in the conservative and surgical groups.
Conclusion: In select patients with pituitary apoplexy good visual symptoms can be achieved with conservative management. Long term tumour control was seen in three quarters of patients who did not undergo surgery, suggesting apoplexy may lead to complete tumour necrosis in majority of cases.
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