Trends and Outcomes in Pituitary Apoplexy Management: A Spanish Observational Multicenter Study

BACKGROUND AND OBJECTIVE: Currently, the management for pituitary apoplexy (PA) has been promoted toward a more conservative approach, particularly for patients with low-grade PA scores. Our aim was to investigate trends in PA management and compare clinical presentation, therapeutic approaches, and outcomes before and after 2017, additionally to evaluate long-term outcomes in conservatively treated patients. METHODS: Spanish multicenter, retrospective study. Statistical analyses compared clinical presentation and outcomes between periods, adjusting for confounders. RESULTS: A total of 215 patients with PA and nonfunctioning pituitary adenoma were included, with the median age of 62.2 years and 68.4% were male patients. Of which 94 (43.7%) were diagnosed before 2017 and 121 (56.3%) in 2017 or later. Conservative treatment increased from 17% before to 30.6% in the recent period (odd ratio 0.47, 95% CI 0.24-0.90, P 0.02) This trend remained significant after adjusting for hospital, age, and Knosp grade (odd ratio 0.46, 95% CI 0.22-0.89, P = .03). However, surgery remained the most frequently used therapeutic option in both periods. There were no statistically significant differences in outcomes at 3 months between periods. Surgery compared with conservative management was associated with higher permanent arginine vasopressin deficiency in both periods (0 vs 17.9%, P = .07 before 2017; 0 vs 16.7%, P = .01 after). Up to 89.7% of patients treated conservatively, presented more than 25% spontaneous tumor shrinkage, and 74.4% had more than 50% tumor reduction. CONCLUSION: Although conservative management increased in the last years, surgery remains the predominant option. Patients managed conservatively experience a lower risk of permanent arginine vasopressin deficiency, and a high proportion exhibit clinically significant tumor shrinkage over time.