1a5c24e31a97c2994be48f73a13807e7 pmc_9786023.pdf 989eedf74e9c559e0c2c08f33fa9d2ec7260a671 pmc_9786023.pdf 69dff7804588c75d446f3e024f76fd9c46ef2aef224def7394b9ebb48ef155fc pmc_9786023.pdf Title: Risk Factors, Radiological and Clinical Outcomes in Subclinical and Clinical Pituitary Apoplexy Subject: Background: Pituitary apoplexy (PA) can be symptomatic, namely acute apoplexy (APA), or asymptomatic or subclinical (SPA). Objective: To describe the clinical characteristics and evolution of the patients with APA compared to SPA Patients and methods: Retrospective, longitudinal database analysis. Results: We identified 58 patients with PA, and 37 accomplished the inclusion criteria (17 men, median age 47.7 years). A total of 29 (78.4%) had APA (17 underwent surgery, and 12 were conservatively managed), and 8 (21.6%) had SPA. The presence of non-functioning pituitary adenoma (NFPA) odds ratio (OR): 29.36 (95% confidence interval (CI): 1.86–462.36) and the largest size OR 1.10 (95% CI: 1.01–1.2) elevated the risk of having surgery. Hypopituitarism developed in 35.1% without significant differences between APA and SPA. In non-surgical patients, adenoma volume shrunk spontaneously at one year magnetic resonance imaging (MRI), without statistical differences between the conservatively treated and SPA group. Conclusions: APA is more frequent in larger NFPAs, and this subset of patients has a higher risk of surgery. Hypopituitarism is quite frequent even in patients with SPA, and, therefore, long-term follow-up is mandatory. In the non-surgical group, the pituitary tumour shrinkage is clinically relevant after one year of PA. Consequently, surgery indication in NFPA should be delayed and reassessed if patients remain asymptomatic. Keywords: pituitary apoplexy; pituitary adenoma; hemorrhage; necrosis; neurosurgery; emergency; subclinical apoplexy Author: Betina Biagetti, Silvana Sarria-Estrada, Esteban Cordero Asanza, Anas Chaachou-Charradi, Yiken Karelys Ng-Wong, Marta Cicuendez, Irene Hernandez, Alba Rojano-Toimil, Pilar Costa, Elena Martinez-Saez, Anna Casteràs and Rafael Simò Creator: LaTeX with hyperref Producer: pdfTeX-1.40.21 CreationDate: Thu Dec 8 10:56:45 2022 CET ModDate: Thu Dec 8 11:05:52 2022 CET Tagged: no UserProperties: no Suspects: no Form: none JavaScript: no Pages: 13 Encrypted: no Page size: 595.276 x 841.89 pts (A4) Page rot: 0 File size: 1438246 bytes Optimized: no PDF version: 1.7 name type encoding emb sub uni object ID ------------------------------------ ----------------- ---------------- --- --- --- --------- WEJWXD+VnURWPalladioL Type 1 Custom yes yes no 10 0 KNDHWF+URWPalladioL-Bold Type 1 Custom yes yes no 15 0 XCTHMJ+URWPalladioL-Roma Type 1 Custom yes yes no 20 0 QAPKFM+URWPalladioL-Ital Type 1 Custom yes yes no 24 0 KGSVEK+VnURWPalladioL-Bold Type 1 Custom yes yes no 28 0 XPUSBJ+TimesNewRomanPS-BoldItalicMT Type 1C WinAnsi yes yes no 46 0 BSDWLC+TimesNewRomanPSMT Type 1C WinAnsi yes yes no 49 0 OJBAFK+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 83 0 OJBAFM+PalatinoLinotype TrueType WinAnsi yes yes no 86 0 OJBAGN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 89 0 OJBCIB+Arial CID TrueType Identity-H yes yes yes 92 0 SSJMKU+CMSY10 Type 1 Builtin yes yes no 102 0 ZIPEAN+EURM10 Type 1 Builtin yes yes no 106 0 QLBIEB+URWPalladioL-BoldItal Type 1 Custom yes yes no 113 0 OJBAFK+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 126 0 OJBAFM+PalatinoLinotype TrueType WinAnsi yes yes no 129 0 OJBAGN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 132 0 OJBDOL+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 135 0 OJBAFK+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 155 0 OJBAFM+PalatinoLinotype TrueType WinAnsi yes yes no 158 0 OJBAGN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 161 0 OJBAFK+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 172 0 OJBAFM+PalatinoLinotype TrueType WinAnsi yes yes no 175 0 OJBAGN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 178 0 OJBAFK+PalatinoLinotype,Bold TrueType WinAnsi yes yes no 192 0 OJBAFM+PalatinoLinotype TrueType WinAnsi yes yes no 195 0 OJBAGN+PalatinoLinotype,Italic TrueType WinAnsi yes yes no 198 0 OJBDOL+PalatinoLinotype,BoldItalic TrueType WinAnsi yes yes no 201 0 Jhove (Rel. 1.22.1, 2019-04-17) Date: 2023-08-03 02:25:17 CEST RepresentationInformation: pmc_9786023.pdf ReportingModule: PDF-hul, Rel. 1.12.1 (2019-04-17) LastModified: 2023-08-02 02:21:10 CEST Size: 1438246 Format: PDF Version: 1.7 Status: Well-Formed and valid SignatureMatches: PDF-hul MIMEtype: application/pdf PDFMetadata: Objects: 364 FreeObjects: 1 IncrementalUpdates: 0 DocumentCatalog: PageLayout: SinglePage PageMode: UseNone Outlines: Item: Title: Introduction Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@44c8afef Item: Title: Patients and Methods Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7b69c6ba Item: Title: Results Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@46daef40 Children: Item: Title: Main Differences between SPA and APA Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@12f41634 Item: Title: Differences between Patients with Conservative vs. Surgical Approach in APA Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@13c27452 Item: Title: Clinical and Radiological Outcomes Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@262b2c86 Item: Title: Pathology Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@371a67ec Item: Title: Prediction Model for Surgery: Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@5ed828d Item: Title: Discussion Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@50d0686 Item: Title: References Destination: edu.harvard.hul.ois.jhove.module.pdf.PdfSimpleObject@7a3d45bd Info: Title: Risk Factors, Radiological and Clinical Outcomes in Subclinical and Clinical Pituitary Apoplexy Author: Betina Biagetti, Silvana Sarria-Estrada, Esteban Cordero Asanza, Anas Chaachou-Charradi, Yiken Karelys Ng-Wong, Marta Cicuendez, Irene Hernandez, Alba Rojano-Toimil, Pilar Costa, Elena Martinez-Saez, Anna Casteràs and Rafael Simò Subject: Background: Pituitary apoplexy (PA) can be symptomatic, namely acute apoplexy (APA), or asymptomatic or subclinical (SPA). Objective: To describe the clinical characteristics and evolution of the patients with APA compared to SPA Patients and methods: Retrospective, longitudinal database analysis. Results: We identified 58 patients with PA, and 37 accomplished the inclusion criteria (17 men, median age 47.7 years). A total of 29 (78.4%) had APA (17 underwent surgery, and 12 were conservatively managed), and 8 (21.6%) had SPA. The presence of non-functioning pituitary adenoma (NFPA) odds ratio (OR): 29.36 (95% confidence interval (CI): 1.86 462.36) and the largest size OR 1.10 (95% CI: 1.01 1.2) elevated the risk of having surgery. Hypopituitarism developed in 35.1% without significant differences between APA and SPA. In non-surgical patients, adenoma volume shrunk spontaneously at one year magnetic resonance imaging (MRI), without statistical differences between the conservatively treated and SPA group. Conclusions: APA is more frequent in larger NFPAs, and this subset of patients has a higher risk of surgery. Hypopituitarism is quite frequent even in patients with SPA, and, therefore, long-term follow-up is mandatory. In the non-surgical group, the pituitary tumour shrinkage is clinically relevant after one year of PA. Consequently, surgery indication in NFPA should be delayed and reassessed if patients remain asymptomatic. 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