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. 2025 Jun 4:12:1579498.
doi: 10.3389/fsurg.2025.1579498. eCollection 2025.

Pituitary apoplexy: surgical or conservative? A meta-analytical insight

Kailai Xia #  1 , Jihong Peng #  2 , Yunhao Zhou #  2 , Xiaoqing Liu  3 , Hongyu Chen  3 , Haiyang Xu  2 , Shuangji Wang  2 , Aini Deng  2 , Hua Tang  1 , Jinyang Hu  1
Affiliations

Pituitary apoplexy: surgical or conservative? A meta-analytical insight

Kailai Xia et al. Front Surg. .

Abstract

Objectives: The challenge in treating pituitary apoplexy lies in choosing between conservative management and surgical intervention, with a current lack of high-level medical evidence to guide the selection of treatment options. This study compares the recovery rates of typical clinical manifestations following surgical and conservative treatments, aiming to provide evidence-based medical support for clinical treatment decisions.

Methods: Relevant literature published between 1991 and 2024 was searched using PubMed, Embase, Cochrane Libraries, and CNKI. After a rigorous screening process to apply the inclusion and exclusion criteria, the primary clinical observation indicators were carefully extracted. The recovery rates of the main clinical observation indicators were evaluated using Reman v5.3. A fixed-effects model was employed to determine the merged odds ratio (OR) values, utilizing the Mantel-Haenszel estimation method. Publication bias was assessed using a funnel plot. Heterogeneity between studies was analyzed with the Cochran Q (Chi-square) test and I² statistics.

Results: The meta-analysis results indicated that surgical treatment significantly improved recovery from ocular muscle paralysis compared to conservative treatment (OR: 0.31; 95% CI 0.10-0.92; p = 0.04). However, no statistically significant differences were observed in postoperative recovery of visual acuity (OR: 1.15; 95% CI 0.54-2.44; p = 0.72), visual field recovery (OR: 1.48; 95% CI 0.77-2.82; p = 0.24), or pituitary endocrine function (OR: 0.67; 95% CI 0.27-1.67; p = 0.38).

Conclusion: Our research findings suggest that patients with pituitary apoplexy presenting with ocular palsy may benefit more from surgical treatment.

Keywords: conservative treatment; meta-analysis; pituitary apoplexy; surgical treatment; systematic review.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PRISMA flow chart.
Figure 2
Figure 2
(A) Surgical versus conservative treatment efficacy aiming for visual acuity was compared. (B) Funnel plot for detecting and displaying system heterogeneity.
Figure 3
Figure 3
(A) The surgical treatment was compared to the conservative treatment for its efficacy in the visual field. (B) Funnel plot for detecting and displaying system heterogeneity.
Figure 4
Figure 4
(A) Conservative and surgical treatments were compared in terms of their effectiveness in treating pituitary endocrine function. (B) Funnel plot for detecting and displaying system heterogeneity.
Figure 5
Figure 5
(A) Comparing the efficacy of conservative treatments and surgical treatments for ocular palsy. (B) Funnel plot for detecting and displaying system heterogeneity.
See this image and copyright information in PMC

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References

    1. Briet C, Salenave S, Bonneville JF, Laws ER, Chanson P. Pituitary apoplexy. Endocr Rev. (2015) 36:622–45. 10.1210/er.2015-1042 - DOI - PubMed
    1. Liu ZH, Chang CN, Pai PC, Wei KC, Jung SM, Chen NY, et al. Clinical features and surgical outcome of clinical and subclinical pituitary apoplexy. J Clin Neurosci. (2010) 17:694–9. 10.1016/j.jocn.2009.11.012 - DOI - PubMed
    1. Mou C, Han T, Zhao H, Wang S, Qu Y. Clinical features and immunohistochemical changes of pituitary apoplexy. J Clin Neurosci. (2009) 16:64–8. 10.1016/j.jocn.2008.02.012 - DOI - PubMed
    1. Moscona-Nissan A, Sidauy-Adissi J, Hermoso-Mier KX, Glick-Betech SS, Chávez-Vera LJ, Martinez-Mendoza F, et al. Diagnosis and treatment of pituitary apoplexy, A true endocrine emergency. Arch Med Res. (2024) 55:103001. 10.1016/j.arcmed.2024.103001 - DOI - PubMed
    1. Almeida JP, Sanchez MM, Karekezi C, Warsi N, Fernández-Gajardo R, Panwar J, et al. Pituitary apoplexy: results of surgical and conservative management clinical series and review of the literature. World Neurosurg. (2019) 130:e988–99. 10.1016/j.wneu.2019.07.055 - DOI - PubMed

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