Aims: Apoplexy might be the first sign of a pituitary adenoma with rapid onset and severe symp-toms. Since it is a life-threatening condition, immediate medical attention is crucial. This study aimed to characterize the clinical presentation of pituitary apoplexy (PA) and compare out-comes following acute neurosurgical intervention and conservative management in a large endocrine referral centre in Hungary.
Methods: Clinical data, as well as radiological and hormonal investigation results of patients with MRI-confirmed PA were retrospectively analysed. For statistical analysis, descriptive methods were used.
Results: Twenty-seven patients were enrolled who were diagnosed between 1975 and 2024. The aver-age follow-up time is 70,9±29,2 months. Fifty-nine percent of patients were male. The mean age at diagnosis was 47,9±18,0 years. Twenty patients had macroadenomas with a mean size of 26,7±13,0 mm. Eight adenomas were invasive. In 18 cases (77%), the adenoma was hor-monally inactive, seven patients had hyperprolactinemia and two patients had acromegaly di-agnosed before the apoplexy. The most common manifestations were headache (59%), cranial nerve palsy (33%), visual disturbances (22%), nausea and vomiting (18%). Twenty-six (96%) patients became deficient in at least one anterior pituitary hormone. The relative frequency of hormone insufficiencies was as follows: ACTH 96%, TSH 74%, LH/ FSH 59%, arginine-vasopressin: 26%, GH: 18%. Except one, all patients received glucocorticoid substitution. Fif-teen patients were treated with surgical intervention, twelve patients were managed conserva-tively. However, after 2020, only two out of nine patients (22%) underwent surgical interven-tion, and both of them had severe visual impairment. Data were available in 19 cases for the retrospective calculation of pituitary apoplexy scores (PAS). There was no difference in the median of the PAS between the two treatment groups (2,0 vs 0,0 NS) The prevalence of long-term neuro-ophthalmological sequelae of PA was also similar in these two groups (8/14 vs. 2/10, p=0.074).
Conclusion: In almost all cases, PA leads to pituitary insufficiency, with frequent deficiencies in ACTH and TSH secretion. Acute surgical intervention rarely provides long-term benefit in neuro-ophthalmological outcome.