Visual and Endocrine Recovery following Conservative and Surgical Treatment of Pituitary Apoplexy: A Meta-analysis

Introduction: Pituitary apoplexy (PA) can present with visual and endocrine defects. The literature lacks strong support for either surgical or conservative management with respect to symptomatic improvement of these deficits. This meta-analysis compares the visual and endocrine outcomes in conservative and surgical treatment of PA.

Methods: A systematic literature search was performed in PubMed, Cochrane, and Ovid MEDLINE for articles published between 1988 and 2018. Recovery outcomes were binarized, such that complete and partial improvements were combined as “improvement.” The primary outcome variables evaluated via a binary random-effects model were improvements in endocrine dysfunction, visual field and acuity deficits, and ophthalmoplegia or ocular nerve palsy (O/ONP).

Results: Of 483 published articles, 14 studies of a collective 457 cases (259 surgical and 198 conservative) were included. On initial examination, 58% of patients had endocrine dysfunction, 37% had visual acuity or field deficit, and 47% had O/ONP. Evaluation of outcomes for surgically and conservatively managed patients yielded odds ratios of 0.609 (95% CI: 0.199–1.859; p = 0.383), 0.763 (95% CI: 0.307–2.374; p = 0.763), 1.167 (95% CI: 0.433–3.146; p = 0.760), and 0.801 (95% CI: 0.305–2.105; p = 0.653) for improvements in endocrine dysfunction, visual acuity dysfunction, visual field dysfunction, and ONP/O, respectively.

Conclusion: Both surgical intervention and conservative management of PA can lead to visual and endocrine recovery, though the management decision may heavily rely on the severity of initial deficits. Treatment of PA can be multifaceted and tailored to the individual case and clinical judgment. Further investigation into the appropriate intervention based on longitudinal outcome data is warranted.