Subtotal Resection of Pituitary Apoplexy Is Associated with Recurrent Apoplexy

Objective Pituitary apoplexy is an uncommon clinical condition that can require urgent surgical intervention. The purpose of this study is to determine the risks of a recurrent apoplexy to further delineate the goals of surgical intervention.

Methods A retrospective chart review was performed for all consecutive patients diagnosed and surgically treated for pituitary apoplexy from 2004 to 2016. Demographic, radiographic, endocrinologic, ophthalmologic, and operative variables were collected. Univariate analyses were performed initially to determine the relationship between the degree of tumor resection to tumor size, tumor location, type of apoplexy, and recurrence of apoplexy. Multivariate analyses were then performed for the significant associations.

Results A total of 82 patients were diagnosed with pituitary apoplexy. There was a male predominance (67%), with a mean age of 54.1 years. The majority were diagnosed with the hemorrhagic type of apoplexy (86.6%), with the average tumor volume at 7.9 cm³ (SD: 5.2) and 43% with cavernous sinus invasion. A prolactinoma was diagnosed in seven patients (8.6%). A total of three patients received radiation (3.7%). Gross total resection (GTR) was achieved in 46 (56.1%), near-total resection (NTR) in 17 (20.7%), and subtotal resection in 19 (23.2%) patients. Recurrent apoplexy occurred in 10 patients (12.2%). All recurrent apoplexy cases occurred in hemorrhagic adenomas.

Univariate analyses for recurrent apoplexy were significantly associated with prior radiation treatment (p < 0.0001) and subtotal resection (p < 0.0001). The logistic regression model confirmed the significance of prior radiation treatment (p = 0.01), degree of resection (p < 0.0001), and type of apoplexy (p = 0.03). The history of hypertension, anticoagulation use, gender, age, tumor size, and cavernous sinus invasion were not associated with recurrence of apoplexy.

Conclusion Severe symptomatic pituitary apoplexy may require urgent surgical intervention. In this setting, despite the fact that decompression is often the primary goal, it is prudent to maximize surgical resection to decrease the likelihood of recurrent apoplexy.