Endoscopic Endonasal Transsphenoidal Resection of Pituitary Apoplexy: Assessment of Visual and Endocrine Outcomes

Background: Pituitary apoplexy (PA) is a rare clinical syndrome typically caused by acute hemorrhage or infarction of a pituitary adenoma. We analyzed a series of patients with PA who underwent endoscopic endonasal transsphenoidal surgery (EETS) and assessed clinical outcomes.

Methods: A retrospective chart review was performed on 28 patients diagnosed with PA between August 2009 and June 2019. Data was collected regarding patient demographics, presenting symptoms, postoperative complications, pathology, and clinical outcomes.

Results: Twenty-eight patients (12 females, 16 males; mean age, 50.19 ± 14.40 years; mean follow-up, 5.67 ± 6.33 months) underwent EETS. Common presenting symptoms included headache (89.3%), visual acuity deficit (60.7%), nausea/vomiting (50.0%), ocular paresis (46.2%), and visual field deficit (35.7%). Most common presenting endocrine abnormalities included hypothyroidism (60.7%), and hypoprolactinemia (28.6%). All adenomas were macroadenomas, either hemorrhagic (25.0%) or necrotic (28.6%), or both. Sphenoid sinus mucosal thickening was present in 53.6% of cases. After EETS, improvement or normalization in visual function was noted in at least 80% and improvement in ocular paresis in 100%. Endocrine outcomes varied. Hormone replacement therapy was administered to 61.5% of patients postoperatively. Five patients had temporary diabetes insipidus (DI), and two had long-term DI. There were no postoperative CSF leaks and no deaths.

Conclusion: EETS is a safe and effective approach for the surgical treatment of PA, where visual and ocular paresis symptoms were more likely to improve or normalize than endocrine. Timely recognition of PA may further improve patient visual outcomes after EETS.

No conflict of interest has been declared by the author(s).