Recurrent pituitary apoplexy: experience from a national registry and review of the literature
Por:
Biagetti, B, Asanza, EC, Iglesias, P, Camara, R, Asla, Q, Vicente, A, Martinez-Saez, E, Sarria-Estrada, S, Puig-Domingo, M, Araujo-Castro, M
Publicada:
1 ene 2026
Resumen:
Background: Pituitary apoplexy (PA) is a neuroendocrine emergency characterized by acute hemorrhage or infarction of a pituitary adenoma. While its initial presentation and management are well documented, data on recurrent PA remain scarce.Objectives: To determine the prevalence, clinical characteristics, and predictors of recurrent PA in a national cohort, and to contextualize findings through a structured review of the literature.Design: Multicenter retrospective cohort study complemented by a structured literature review.Methods: We analyzed 274 patients from the Spanish Pituitary Apoplexy Registry (2010-2023) with complete follow-up. Recurrent PA was defined as a new acute episode with radiological evidence of hemorrhage or infarction within a previously affected lesion. Clinical, radiological, and treatment-related variables were compared between recurrent and non-recurrent cases. A complementary literature review identified published reports of recurrence.Results: Recurrent PA occurred in 9 patients (3.3%), including 6 of 214 with nonfunctioning adenomas (2.8%) and 3 of 60 with functioning adenomas (5.0%). Compared with nonrecurrent cases, patients with recurrence had significantly larger tumors (median 35 vs 25 mm; p = 0.006), higher rates of cavernous sinus invasion (77.9% vs 37.3%; p = 0.006), and more frequent prior cabergoline therapy (33.3% vs 6.3%; p = 0.020). Median time to recurrence was 18 months (range, 2-108). The literature review identified 11 studies reporting recurrence rates of 2.6%-16.7%, with more consistent estimates (4%-9.6%) in larger series (n >= 50). All recurrent cases showed a favorable clinical course and recovery.Conclusion: Recurrent PA is uncommon, affecting approximately 3% of patients with a prior apoplexy episode. Given the low frequency of recurrence, the associated factors identified should be interpreted cautiously and considered primarily hypothesis-generating. The second episode was not more severe than the initial event, and the long-term prognosis was favorable.Trial registration: Not applicable.
Filiaciones:
Asanza, EC:
Univ Autonoma Barcelona, Hosp Univ Vall Hebron, Neurosurg Dept, Barcelona, Spain
Iglesias, P:
Hosp Univ Puerta Hierro Majadahonda, Inst Invest Sanitaria Puerta Hierro Segovia Arana, Dept Endocrinol, Majadahonda, Spain
Univ Autonoma Madrid, Dept Med, Madrid, Spain
Camara, R:
La Fe Univ Hosp, Endocrinol & Nutr Serv, Valencia, Spain
Asla, Q:
Hosp Santa Creu i St Pau, Endocrinol & Nutr Dept, IR SANTPAU, ENDO ERN, Barcelona, Spain
Vicente, A:
Hosp Univ Toledo, Endocrinol & Nutr Dept, Toledo, Spain
Martinez-Saez, E:
Univ Autonoma Barcelona, Hosp Univ Vall Hebron, Pathol Dept, Barcelona, Spain
Sarria-Estrada, S:
Vall dHebron Univ Hosp, Vall dHebron Barcelona Hosp Campus, Radiol Dept, Neuroradiol Sect, Barcelona, Spain
Puig-Domingo, M:
Germans Trias Hosp & Res Inst, Endocrinol & Nutr Serv, Badalona, Spain
Univ Autonoma Barcelona, Ctr Invest Biomed Red Enfermedades Raras U747, Badalona, Spain
Araujo-Castro, M:
Endocrinology and Nutrition Department, Hospital Universitario Ramón y Cajal, Colmenar Viejo Street km 9, Madrid 28034, Spain.
Instituto de Investigación Biomédica Ramón y Cajal, Madrid, Spain.
Green Submitted, gold
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