gms | German Medical Science

Objective: Pituitary apoplexy is a serious medical complication of a pre-existing pituitary adenoma characterized by a variety of clinical symptoms ranging from mild headache to neurologically impaired and finally comatose patients. Surgery is commonly reserved for acute neurologically and visually compromised patients. Prospective studies showing a benefit of surgery over conservative treatment in terms of visual, neurological and even endocrine outcome are lacking. Decision making is still controversial, recommendations for surgery are based on low evidence grades and focus on visual impairment. Endocrine function and especially markers identifying patients with potential for pituitary recovery after surgery are not well described in the literature. The aim of this study is to assess possible predictive markers for recovery in a long term follow up.

Methods: All patients with pituitary apoplexy that were treated surgically from 05/2013 to 01/2017 in our center regardless of time from symptom onset were enrolled in this study. Endocrinological work up consisted of preoperative basal hormone evaluation and postoperative evaluation at day 5, 3 and 6 months postoperative respectively. MRI follow-up and clinical examination was performed addtionally after 3, 6 and 12months on a routine basis.

Results: We prospectively collected data from 24 patients (men:women / 16:8) with a median age of 64 yrs (range 38 to 83yrs). Apoplexies were necrotic in 14 cases and haemorrhagic in 10 cases. Preoperatively 6 patients (25%) had complete anterior pituitary insufficiency, 16 patients (66,6%) had partial anterior pituitary insufficiency and one patient (4,17%) had normal function. In the long term follow up after 6 months persistent panhypopituitarism was found in 29,2%, whereas an overall improvement of pituitary function was noted in 57,1% of the patients. Preoperative prolactin (PRL) levels were significantly associated with recovery of endocrine function. This meant that all patients with preoperative PRL levels above 8.8ng/ml recovered partially or fully.

Conclusion: Our data emphasize that normal and high preoperative PRL levels are associated with better endocrine outcome after surgery. Furthermore, we can show that even patients with symptoms longer than 7 days benefit from surgery when PRL secretion is normal. Therefore, we recommend surgical intervention even after that time considering serum PRL level as a valid biomarker for clinical decision making.