• Betina Biagetti, Esteban Cordero Asanza, Pablo García-Feijoo, Marta Araujo-Castro, Víctor Rodríguez Berrocal, Guillermo Serra, Fernando Guerrero-Pérez, Rosa Cámara, Cristina Lamas, M Dolores Ollero García, Almudena Vicente, Ana Irigaray Echarri, Rocío Villar-Taibo, María Dolores Moure Rodríguez, Carlos Pérez-López, Inmaculada González-Molero, María Noelia Sánchez Ramírez, Alba Gutiérrez Hurtado, Vanessa Capristan-Díaz, Andreu Simó-Servat, Marta Gallach, Eva Safont Pérez, Victoria González Rosa, Soralla Civantos, Elena Martinez-Saez, Julia García-Arabehety, Edelmiro Menéndez Torre, Anna Aulinas, Pedro Iglesias, Juan J Díez, Ignacio Bernabéu, Cristina Álvarez-Escolá, Manel Puig-Domingo, and Neuroendocrinology Area of the Spanish Society of Endocrinology.
• Endocrinology & Nutrition Department, Hospital Universitario Vall d'Hebrón, CIBERER U747 (ISCIII), ENDO-ERN, Universitat Autónoma de Barcelona, Barcelona, Spain.
• Neurosurgery. 2024 Dec 5.

Background And ObjectiveCurrently, 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.MethodsSpanish multicenter, retrospective study. Statistical analyses compared clinical presentation and outcomes between periods, adjusting for confounders.ResultsA 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.ConclusionAlthough 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.

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