Abstract
Introduction Pituitary apoplexy is an uncommon clinical condition that can require urgent surgical
intervention, but the factors resulting in recurrent apoplexy remain unclear. The
purpose of this study is to determine the risks of a recurrent apoplexy and better
understand the goals of surgical treatment.
Methods A retrospective chart review was performed for all consecutive patients diagnosed
and surgically treated for pituitary apoplexy from 2004 to 2021. Univariate analysis
was performed to identify risk factors associated with recurrent apoplexy.
Results A total of 115 patients were diagnosed with pituitary apoplexy with 11 patients showing
recurrent apoplexy. This occurred at a rate of 2.2 cases per 100 patient-years of
follow-up. There were no major differences in demographic factors, such as hypertension
or anticoagulation use. There were no differences in tumor locations, cavernous sinus
invasion, or tumor volumes (6.84 ± 4.61 vs. 9.15 ± 8.45 cm, p = 0.5). Patients with recurrent apoplexy were less likely to present with headache
(27.3%) or ophthalmoplegia (9.1%). Recurrent apoplexy was associated with prior radiation
(0.0 vs. 27.3%, p = 0.0001) and prior subtotal resection (10.6 vs. 90.9%, p = 0.0001) compared with first time apoplexy. The mean time to recurrent apoplexy
was 48.3 ± 76.9 months and no differences in overall follow-up were seen in this group.
Conclusion Recurrent pituitary apoplexy represents a rare event with limited understanding of
pathophysiology. Prior STR and radiation treatment are associated with an increased
risk. The relatively long time from the first apoplectic event to a recurrence suggests
long-term patient follow-up is necessary.
Keywords
pituitary adenoma - apoplexy - endoscopic - recurrent hemorrhage - radiation
