Pituitary Apoplexy: Comorbidities, Management, and Outcomes-A Spanish Observational Multicenter Study
Por:
Biagetti, B, Asanza, EC, Pérez-López, C, Araujo-Castro, M, Camara, R, Guerrero-Pérez, F, Vicente, A, Lamas, C, Serra, G, Echarri, AI, Ollero, MD, Molero, IG, Villar-Taibo, R, Rodríguez, MDM, Garcia-Feijoo, P, Berrocal, VR, Ramirez, MNS, Hurtado, AG, Capristan-Díaz, V, Simó-Servat, A, Gallach, M, Perez, ES, Rosa, VG, Civantos, S, Asensio-Wandosell, D, Martinez-Saez, E, Torre, EM, Aulinas, A, Iglesias, P, Diez, JJ, Bernábeu, I, Alvarez-Escolá, C, Puig-Domingo, M
Publicada:
1 jun 2025
Ahead of Print:
1 oct 2024
Resumen:
Background: Pituitary apoplexy (PA) is the paradigm of endocrine and neurosurgical emergency. Objective: To evaluate the comorbidities, risk factors, clinical presentation, pituitary apoplexy score (PAS), and the outcomes of surgical vs conservative management of PA in Spain. Methods: Spanish multicenter, observational study of 301 patients with acute PA. Statistical analyses compared risk factors, clinical presentation, and outcomes between surgical and conservative treatment groups, adjusting for potential confounders. The prevalence of cardiovascular risk factors in patients with PA was compared with the Spanish population and with patients with nonfunctioning pituitary adenomas. Results: Median age was 59.3 years, 201 (66.8%) were men; nonfunctioning adenomas (77.9%) were the most common tumor type. The prevalence of diabetes (20.3% vs 13.9%, P < .01), hypertension (48.8% vs 33.4%, P < .01), and dyslipidemia (44.2% vs 23.3%, P < .01), exceeded the Spanish age-adjusted population prevalence. Overall, 209 (69.4%) underwent surgery and 92 (30.6%) received conservative treatment. Surgical patients had larger tumors (26.2 vs 21.0 mm, P < .01), more frequent chiasmal compression (77.2% vs 53.4%, P < .01), and higher values of PAS. In the follow-up, although there were no statistically significant differences in anterior pituitary hormonal deficits between treatments, permanent vasopressin deficiency was more frequent after surgery (14.8% vs 3.3%, P < .01). Conclusions: There is a high burden of cardiovascular risk factors among patients with PA, suggesting that metabolic factors may play a potential role in the development of PA. This underscores the need for comprehensive management of these conditions in addition to treating the apoplexy itself in this population. Surgical management has a relevant place in PA approach mainly in patients with higher PAS. However, it leads a permanent vasopressin deficit more frequently than a conservative approach.
Filiaciones:
Biagetti, B:
Univ Autonoma Bracelona, Hosp Univ Vall de Hebron, Endocrinol & Nutr Dept, ENDO ERN,CIBERER U747 ISCIII, Barcelona 08032, Spain
Asanza, EC:
Univ Autonoma Barcelona, Hosp Univ Vall Hebron, Neurosurg Dept, Barcelona 08032, Spain
Pérez-López, C:
Hosp Univ La Paz, Dept Neurosurg, Madrid, Spain
Araujo-Castro, M:
Hosp Univ Ramon y Cajal, Dept Endocrinol & Nutr, Madrid 28034, Spain
Camara, R:
La Fe Univ Hosp, Endocrinol & Nutr Serv, Valencia 46026, Spain
Guerrero-Pérez, F:
Hosp Univ Bellvitge, Dept Endocrinol, Lhospitalet De Llobregat 08907, Barcelona, Spain
Vicente, A:
Hosp Univ Toledo, Endocrinol & Nutr Dept, Toledo 45007, Spain
Lamas, C:
Hosp Univ Albacete, Endocrinol & Nutr Dept, Albacete 02006, Spain
Serra, G:
Son Espases Univ Hosp, Dept Endocrinol, Palma De Mallorca 07120, Spain
Echarri, AI:
Univ Hosp Navarre, Dept Endocrinol, Pamplona 31008, Spain
Ollero, MD:
Univ Hosp Navarre, Dept Endocrinol, Pamplona 31008, Spain
Molero, IG:
Hosp Reg Univ Malaga, Endocrinol & Nutr Dept, Inst IBIMA Plataforma BIONAND Malaga, Malaga 29010, Spain
Villar-Taibo, R:
Hosp Univ Santiago de Compostela, Endocrinol & Nutr Dept, La Coruna 15706, Spain
Rodríguez, MDM:
Hosp Univ Cruces, Dept Hepatol Unit, Bilbao 48903, Spain
Garcia-Feijoo, P:
Hosp Univ La Paz, Dept Neurosurg, Madrid, Spain
Berrocal, VR:
Hosp Univ Ramon y Cajal, Dept Neurosurg, Madrid 28034, Spain
Ramirez, MNS:
Hosp Univ Ramon y Cajal, Dept Endocrinol & Nutr, Madrid 28034, Spain
Hurtado, AG:
Hosp Univ Cent Asturias, Endocrinol & Nutr Dept, Inst Invest Principado Asturias ISPA, Asturias 33011, Spain
Capristan-Díaz, V:
Hosp Univ Puerta de Hierro Majadahonda Segovia de, Dept Endocrinol, Inst Invest Sanitaria Puerta de Hierro, Majadahonda 28220, Spain
Simó-Servat, A:
Mutua de Terrassa Univ Hosp, Dept Endocrinol & Nutr, Terrassa 08221, Spain
Gallach, M:
Hosp Univ Albacete, Endocrinol & Nutr Dept, Albacete 02006, Spain
Perez, ES:
Hosp Santa Creu i St Pau, Endocrinol & Nutr Dept, IR SANTPAU, CIBERER U747 ISCIII,ENDO ERN, Barcelona 08025, Spain
Rosa, VG:
Hosp Univ Insular Gran Canaria, Endocrinol & Nutr Dept, Las Palmas Gran Canaria 35016, Spain
Civantos, S:
Hosp Univ Fuenlabrada, Endocrinol & Nutr Dept, Madrid 28942, Spain
Asensio-Wandosell, D:
Autonomous Univ Barcelona, Germans Trias Hosp & Res Inst, Ctr Invest Biomed Red Enfermedades Raras U747, Endocrinol & Nutr Serv, Barcelona 8916, Spain
Martinez-Saez, E:
Univ Autonoma Barcelona, Hosp Univ Vall de Hebron, Pathol Dept, Barcelona 08032, Spain
Torre, EM:
Hosp Univ Cent Asturias, Endocrinol & Nutr Dept, Inst Invest Principado Asturias ISPA, Asturias 33011, Spain
Aulinas, A:
Mutua de Terrassa Univ Hosp, Dept Endocrinol & Nutr, Terrassa 08221, Spain
Iglesias, P:
Hosp Univ Puerta de Hierro Majadahonda Segovia de, Dept Endocrinol, Inst Invest Sanitaria Puerta de Hierro, Majadahonda 28220, Spain
Univ Autonoma Madrid, Dept Med, Madrid 28049, Spain
Diez, JJ:
Hosp Univ Puerta de Hierro Majadahonda Segovia de, Dept Endocrinol, Inst Invest Sanitaria Puerta de Hierro, Majadahonda 28220, Spain
Univ Autonoma Madrid, Dept Med, Madrid 28049, Spain
Bernábeu, I:
Hosp Univ Santiago de Compostela, Endocrinol & Nutr Dept, La Coruna 15706, Spain
Alvarez-Escolá, C:
Hosp Univ La Paz, Endocrinol Dept, Madrid 28046, Spain
Puig-Domingo, M:
Autonomous Univ Barcelona, Germans Trias Hosp & Res Inst, Ctr Invest Biomed Red Enfermedades Raras U747, Endocrinol & Nutr Serv, Barcelona 8916, Spain
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