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Long-term oncological outcomes after haemorrhagic apoplexy in pituitary adenoma managed operatively and non-operatively

  • Original Article - Pituitaries
  • Published:
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Abstract

Introduction

Depending on severity of presentation, pituitary apoplexy can be managed with acute surgery or non-operatively. We aim to assess long-term tumour control, visual and endocrinological outcomes following pituitary apoplexy with special emphasis on patients treated non-operatively.

Methods

Multicentre retrospective cohort study. All patients with symptomatic pituitary apoplexy were included. Patients were divided into 3 groups: group 1: surgery within 7 days; group 2: surgery 7 days–3 months; group 3: non-operative. Further intervention for oncological reasons during follow-up was the primary outcome. Secondary outcome measures included visual and endocrinological function at last follow-up.

Results

One hundred sixty patients were identified with mean follow-up of 48 months (n = 61 group 1; n = 34 group 2; n = 64 group 3). Factors influencing decision for surgical treatment included visual acuity loss (OR: 2.50; 95% CI: 1.02–6.10), oculomotor nerve palsy (OR: 2.80; 95% CI: 1.08–7.25) and compression of chiasm on imaging (OR: 9.50; 95% CI: 2.06–43.73). Treatment for tumour progression/recurrence was required in 17%, 37% and 24% in groups 1, 2 and 3, respectively (p = 0.07). Urgent surgery (OR: 0.16; 95% CI: 0.04–0.59) and tumour regression on follow-up (OR: 0.04; 95% CI: 0.04–0.36) were independently associated with long-term tumour control. Visual and endocrinological outcomes were comparable between groups.

Conclusion

Urgent surgery is an independent predictor of long-term tumour control following pituitary apoplexy. However, 76% of patients who successfully complete 3 months of non-operative treatment may not require any intervention in the long term.

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Funding

HJM is supported by the NIHR University College London (UCL) Biomedical Research Centre (BRC) and the Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS).

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Author notes

  1. Karol P. Budohoski and Sogha Khawari contributed equally

Authors and Affiliations

  1. Department of Neurosurgery, Cambridge University Hospitals, Cambridge, UK

    Karol P. Budohoski, Angelos Kolias, Prahlad G. Krishnan, Indu Lawes, Thomas Santarius & Richard Mannion

  2. Department of Neurosurgery, National Hospital for Neurology and Neurosurgery, London, UK

    Sogha Khawari, James Arwyn-Jones, Zhangjie Su & Hani J. Marcus

  3. Department of Neurosurgery, Royal Hallamshire Hospital, Sheffield, UK

    Andrea Cavalli & Saurabh Sinha

  4. Department of Neurosurgery, Manchester Centre for Clinical Neurosciences, Salford Royal Hospital, Manchester, UK

    Boon L. Quah, Mueez Waqar, Fiona Cains, Kanna Gnanalingham, Konstantina Karabatsou & Omar N. Pathmanaban

  5. Department of Endocrinology, Cambridge University Hospitals, Cambridge, UK

    Mark Gurnell & Andrew Powlson

  6. Department of Otoloaryngology and Skull Base Surgery, Cambridge University Hospitals, Cambridge, UK

    Neil Donnelly, James Tysome & Rishi Sharma

  7. Department of Ophthalmology, Cambridge University Hospitals, Cambridge, UK

    Brinda Muthusamy

  8. Department of Endocrinology, Salford Royal Hospital, Manchester, UK

    Tara Kearney & Adam Robinson

  9. Geoffrey Jefferson Brain Research Centre, University of Manchester, Manchester, UK

    Ramez W. Kirollos

Authors
  1. Karol P. Budohoski
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  2. Sogha Khawari
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Contributions

KPB and SK participated in the design of the study, collected data, performed the statistical analysis and prepared the manuscript draft. SS, TS, RM and RWK participated in the design of the study and preparation of the manuscript. All authors participated in data collection and data analysis and reviewed and accepted the content of the manuscript.

Corresponding author

Correspondence to Sogha Khawari.

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Study was registered as audit. Study was approved by Institutional Review Boards and was not required to undergo Research Ethics Review.

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The authors declare no competing interests.

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This article is part of the Topical Collection on Pituitaries

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Budohoski, K.P., Khawari, S., Cavalli, A. et al. Long-term oncological outcomes after haemorrhagic apoplexy in pituitary adenoma managed operatively and non-operatively. Acta Neurochir 164, 1115–1123 (2022). https://doi.org/10.1007/s00701-022-05119-8

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  • DOI: https://doi.org/10.1007/s00701-022-05119-8

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