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

Autor:	Biagetti B; Endocrinology & Nutrition Department, Hospital Universitario Vall d'Hebrón, CIBERER U747 (ISCIII), ENDO-ERN, Universitat Autónoma de Barcelona, Barcelona, Spain., Cordero Asanza E; Neurosurgery Department, Hospital Universitario Vall d'Hebrón, Universitat Autónoma de Barcelona, Barcelona, Spain., García-Feijoo P; Department of Neurosurgery, Hospital Universitario La Paz, Madrid, Spain., Araujo-Castro M; Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain.; Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain., Rodríguez Berrocal V; Department of Neurosurgery, Hospital Universitario Ramón y Cajal, Madrid, Spain., Serra G; Department of Endocrinology, Son Espases University Hospital, Palma de Mallorca, Spain., Guerrero-Pérez F; Department of Endocrinology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain., Cámara R; Endocrinology & Nutrition Service, La Fe University Hospital, Valencia, Spain., Lamas C; Endocrinology & Nutrition Department, Complejo Hospitalario Universitario De Albacete, Albacete, Spain., Ollero García MD; Department of Endocrinology, University Hospital of Navarre, Pamplona, Spain., Vicente A; Endocrinology & Nutrition Department, Hospital Universitario de Toledo, Toledo, Spain., Irigaray Echarri A; Department of Endocrinology, University Hospital of Navarre, Pamplona, Spain., Villar-Taibo R; Endocrinology & Nutrition Department, Hospital Universitario de Santiago de Compostela, Madrid, Spain., Moure Rodríguez MD; Endocrinology & Nutrition Department, Hospital Universitario de Cruces, Bilbao, Spain., Pérez-López C; Department of Neurosurgery, Hospital Universitario La Paz, Madrid, Spain., González-Molero I; Endocrinology & Nutrition Department, Hospital Regional Universitario de Málaga, IBIMA Plataforma BIONAND, Málaga, Spain., Sánchez Ramírez MN; Department of Endocrinology and Nutrition, Hospital Universitario Ramón y Cajal, Madrid, Spain.; Instituto de Investigación Biomédica Ramón y Cajal (IRYCIS), Madrid, Spain., Gutiérrez Hurtado A; Endocrinology & Nutrition Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain., Capristan-Díaz V; Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain.; Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain., Simó-Servat A; Department of Endocrinology and Nutrition, Mutua de Terrassa University Hospital, Terrassa, Spain., Gallach M; Endocrinology & Nutrition Department, Complejo Hospitalario Universitario De Albacete, Albacete, Spain., Safont Pérez E; Endocrinology & Nutrition Department, Hospital de la Santa Creu i Sant Pau, IR-SANTPAU, CIBERER-U747 (ISCIII), ENDO-ERN, Barcelona, Spain., González Rosa V; Endocrinology & Nutrition Department, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain., Civantos S; Endocrinology & Nutrition Department, Hospital Universitario Fuenlabrada, Madrid, Spain., Martinez-Saez E; Pathology Department, Vall d'Hebron University Hospital, Barcelona, Spain., García-Arabehety J; Endocrinology & Nutrition Department, Hospital Universitario Vall d'Hebrón, CIBERER U747 (ISCIII), ENDO-ERN, Universitat Autónoma de Barcelona, Barcelona, Spain., Menéndez Torre E; Endocrinology & Nutrition Department, Hospital Universitario Central de Asturias, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Asturias, Spain., Aulinas A; Endocrinology & Nutrition Department, Hospital de la Santa Creu i Sant Pau, IR-SANTPAU, CIBERER-U747 (ISCIII), ENDO-ERN, Barcelona, Spain., Iglesias P; Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain.; Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain., Díez JJ; Department of Endocrinology, Hospital Universitario Puerta de Hierro Majadahonda, Instituto de Investigación Sanitaria Puerta de Hierro Segovia de Arana, Majadahonda, Spain.; Department of Medicine, Universidad Autónoma de Madrid, Madrid, Spain., Bernabéu I; Endocrinology & Nutrition Department, Hospital Universitario de Santiago de Compostela, Madrid, Spain., Álvarez-Escolá C; Endocrinology Department, Hospital Universitario La Paz, Madrid, Spain., Puig-Domingo M; Endocrinology & Nutrition Service, Germans Trias Hospital Research Institute, Badalona, Centro de Investigación Biomédica en Red de Enfermedades Raras U747, Autonomous University of Barcelona, Barcelona, Spain.
Jazyk:	angličtina
Zdroj:	Neurosurgery [Neurosurgery] 2024 Dec 05. Date of Electronic Publication: 2024 Dec 05.
DOI:	10.1227/neu.0000000000003281
Abstrakt:	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. (Copyright © Congress of Neurological Surgeons 2024. All rights reserved.)
Databáze:	MEDLINE
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