Clinical presentation and outcomes of pituitary apoplexy in patients with PitNETs: a real world Italian multicenter study

Purpose: To assess the clinical presentation and the long-term outcomes of pituitary apoplexy in a large cohort of patients with PitNETs. Methods: Retrospective multicenter study, including 177 patients (median age 51 years; 111 males and 66 females) from ten Italian referral centers for PitNETs. All patients > 18 years old with a diagnosis of pituitary apoplexy based on clinical and radiological features were eligible. Clinical and biochemical assessment was performed at the time of apoplexy and after at least 12 months follow-up. Results: At the time of apoplexy, patients with macroadenomas had a higher frequency of headache (83% vs. 50%, p = 0.012), visual field defects (58% vs. 25%, p = 0.035) and symptoms consistent with hypopituitarism (68% vs. 33%, p = 0.024) compared to microadenomas. Men were more likely to present with central adrenal insufficiency (62% vs. 44%; p = 0.028), central hypogonadism (65% vs. 37%, p < 0.001), growth hormone deficiency (35% vs. 19%, p = 0.035) and undergo surgery (69% vs. 31%, p = 0.005). Age also influenced clinical presentation, with central adrenal insufficiency (p = 0.0021), central hypogonadism (p = 0.0045) and growth hormone deficiency (p = 0.0048) being more prevalent in older patients. In terms of outcomes, no differences were observed between patients who underwent surgery and those who did not, except for central hypothyroidism, more prevalent in surgically treated patients (63% vs. 46%, p = 0.041). Nevertheless, 70% of surgically treated patients had pre-existing central hypothyroidism at the time of apoplexy. Conclusion: Tumor size, male sex and age have been demonstrated to affect apoplexy clinical presentation, while the different management strategies do not impact the long-term outcomes.