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Observational Study
. 2025 May 19;110(6):e1811-e1820.
doi: 10.1210/clinem/dgae649.

Pituitary Apoplexy: Comorbidities, Management, and Outcomes-A Spanish Observational Multicenter Study

Betina Biagetti  1 , Esteban Cordero Asanza  2 , Carlos Pérez-López  3 , Marta Araujo-Castro  4 , Rosa Camara  5 , Fernando Guerrero-Pérez  6 , Almudena Vicente  7 , Cristina Lamas  8 , Guillermo Serra  9 , Ana Irigaray Echarri  10 , M Dolores Ollero  10 , Inmaculada González Molero  11 , Rocío Villar-Taibo  12 , María Dolores Moure Rodríguez  13 , Pablo García-Feijoo  3 , Víctor Rodríguez Berrocal  14 , María Noelia Sánchez Ramirez  4 , Alba Gutiéerrez Hurtado  15 , Vanessa Capristan-Díaz  16 , Andreu Simó-Servat  17 , Marta Gallach  8 , Eva Safont Perez  18 , Victoria González Rosa  19 , Soralla Civantos  20 , Diego Asensio-Wandosell  21 , Elena Martinez-Saez  22 , Edelmiro Menéndez Torre  15 , Anna Aulinas  17 , Pedro Iglesias  16   23 , Juan J Diez  16   23 , Ignacio Bernabéu  12 , Cristina Álvarez-Escolá  24 , Manel Puig-Domingo  21
Affiliations
Observational Study

Pituitary Apoplexy: Comorbidities, Management, and Outcomes-A Spanish Observational Multicenter Study

Betina Biagetti et al. J Clin Endocrinol Metab. .

Erratum in

Abstract

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.

Keywords: apoplexy; conservative management; pituitary; risk factors; surgery.

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