A Prospective, Multicenter, Observational Study of Surgical vs Nonsurgical Management for Pituitary Apoplexy.

Autor:	Mamelak AN; Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA., Little AS; Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Medical Center, Phoenix, AZ 85013, USA., Gardner PA; Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA., Almeida JP; Department of Neurosurgery, Mayo Clinic, Jacksonville, FL 32224, USA., Recinos P; Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA., Soni P; Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA., Kshettry VR; Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, OH 44195, USA., Jane JA Jr; Departments of Neurosurgery, Virginia Tech Medical Center, Roanoke, VA 24014, USA., Barkhoudarian G; Pacific Neuroscience Institute, Saint John's Medical Center, Santa Monica, CA 90404, USA., Kelly DF; Pacific Neuroscience Institute, Saint John's Medical Center, Santa Monica, CA 90404, USA., Dodd R; Department of Neurosurgery, Stanford University Medical Center, Stanford, CA 94305, USA., Mukherjee D; Department of Neurosurgery, Johns Hopkins University, Baltimore, MD 21287, USA., Gersey ZC; Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, PA 15213, USA., Fukuhara N; Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo 105-8470, Japan., Nishioka H; Department of Hypothalamic and Pituitary Surgery, Toranomon Hospital, Tokyo 105-8470, Japan., Kim EH; Department of Neurosurgery, Yonsei University College of Medicine, Seoul 03722, Korea., Litré CF; Department of Neurosurgery, CHU de Reims, Reims 51092, France., Sina E; Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA., Mazer MW; Department of Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA., Cui Y; Biostatistic Core, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA., Bonert V; Pituitary Center, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA 90048, USA.
Jazyk:	angličtina
Zdroj:	The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2024 Jan 18; Vol. 109 (2), pp. e711-e725.
DOI:	10.1210/clinem/dgad541
Abstrakt:	Context: Pituitary apoplexy (PA) has been traditionally considered a neurosurgical emergency, yet retrospective single-institution studies suggest similar outcomes among patients managed medically. Objective: We established a multicenter, international prospective registry to compare presentation and outcomes in PA patients treated with surgery or medical management alone. Methods: A centralized database captured demographics, comorbidities, clinical presentation, visual findings, hormonal status, and imaging features at admission. Treatment was determined independently by each site. Key outcomes included visual, oculomotor, and hormonal recovery, complications, and hospital length of stay. Outcomes were also compared based on time from symptom onset to surgery, and from admission or transfer to the treating center. Statistical testing compared treatment groups based on 2-sided hypotheses and P less than .05. Results: A total of 100 consecutive PA patients from 12 hospitals were enrolled, and 97 (67 surgical and 30 medical) were evaluable. Demographics, clinical features, presenting symptoms, hormonal deficits, and imaging findings were similar between groups. Severe temporal visual field deficit was more common in surgical patients. At 3 and 6 months, hormonal, visual, and oculomotor outcomes were similar. Stratifying based on severity of visual fields demonstrated no difference in any outcome at 3 months. Timing of surgery did not affect outcomes. Conclusion: We found that medical and surgical management of PA yield similar 3-month outcomes. Although patients undergoing surgery had more severe visual field deficits, we could not clearly demonstrate that surgery led to better outcomes. Even without surgery, apoplectic tumor volumes regress substantially within 2 to 3 months, indicating that surgery is not always needed to reduce mass effect. (© The Author(s) 2023. Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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