Predictors of conversion to surgery in pituitary apoplexy : Insights from a Spanish multicenter observational study
Biagetti, Betina (Hospital Universitari Vall d'Hebron)
Cordero Asanza, Esteban (Universitat Autònoma de Barcelona)
Pérez-López, Carlos (Hospital Universitario La Paz (Madrid))
Rodríguez Berrocal, Víctor (Hospital Universitario Ramón y Cajal (Madrid))
Vicente, Almudena (Complejo Hospitalario de Toledo)
Lamas, Cristina (Complejo Hospitalario Universitario de Albacete)
Guerrero-Pérez, Fernando (Hospital Universitari de Bellvitge)
Simó-Servat, Andreu (Hospital Universitari MútuaTerrassa)
Serra, Guillermo (Hospital Universitari Son Espases (Palma de Mallorca, Balears))
Echarri, Ana Irigaray (Complejo Hospitalario de Navarra)
Ollero, M.Dolores (Complejo Hospitalario de Navarra)
González Molero, Inmaculada (Hospital Regional Universitario de Málaga)
Villar-Taibo, Rocío (Complejo Hospitalario Universitario de Santiago de Compostela)
Moure Rodríguez, María Dolores (Hospital Universitario de Cruces (Barakaldo, País Basc))
García-Feijoo, Pablo (Hospital Universitario La Paz (Madrid))
Sánchez Ramirez, María Noelía (Hospital Universitari Vall d'Hebron)
Gutiérrez Hurtado, Alba (Hospital Universitario Central de Asturias)
Capristan-Díaz, Vanessa (Universidad Autónoma de Madrid. Departamento de Medicina)
Camara, Rosa (Hospital Universitari i Politècnic La Fe (València))
Gallach, Marta (Complejo Hospitalario Universitario de Albacete)
Safont Perez, Eva (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
González Rosa, Victoria (Hospital Universitario Insular de Gran Canaria)
Civantos-Modino, Soralla (Hospital Universitario de Fuenlabrada ( Madrid))
Martinez-Saez, Elena (Hospital Universitari Vall d'Hebron)
Menéndez Torre, E (Hospital Universitario Central de Asturias)
Aulinas, Anna (Hospital de la Santa Creu i Sant Pau (Barcelona, Catalunya))
Iglesias, Pedro (Universidad Autónoma de Madrid. Departamento de Medicina)
Diez, Juan J. (Universidad Autónoma de Madrid. Departamento de Medicina)
Bernabeu Morón, Ignacio (Complejo Hospitalario Universitario de Santiago de Compostela)
Álvarez-Escolá, Cristina (Hospital Universitario La Paz (Madrid))
Puig Domingo, Manuel (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Araujo-Castro, Marta (Hospital Universitario Ramón y Cajal (Madrid))

Data:	2025
Resum:	Background: Pituitary apoplexy (PA) is a rare but potentially life-threatening condition. While conservative management is an option in selected cases, predictors of conversion to surgery after initial conservative management remain unclear. Objective: To identify predictors of transitioning to surgery in PA who were initially managed conservatively, and to assess the timing and impact of surgical conversion. Methods: This multicenter observational study included 134 patients with PA initially managed conservatively. Patients were categorized into successful conservative management (no surgery or surgery scheduled after 30 days) and conversion to surgery (surgery within 8-30 days). Logistic and Cox regression analyses were performed to identify predictors of conversion to surgery and time to transition, respectively. Results: Among the 134 patients enrolled, the median age was 61. 4 years (interquartile range: 16. 0) years and 93 (69. 4 %) men], 69 (51. 5 %) ultimately required surgery, with most transitions occurring within the first two weeks. In logistic regression analysis, larger tumor size (OR: 1. 09, 95 % CI: 1. 02-1. 16) and higher BMI (OR: 1. 11, 95 % CI: 1. 01-1. 22) were independently associated with conversion to surgery. However, Cox regression did not identify any variables predicting time to transition. Additionally, patients who converted to surgery had a significantly longer hospital stay (21. 0 vs. 7. 5 days, p < 0. 01). Conclusion: Half of the patients initially managed conservatively required convertion to surgery. Tumor size and BMI were associated with an increased likelihood of surgery, but no factors predicted when surgery would occur, suggesting that the decision to conversion to surgery may be influenced by multiple clinical factors rather than a single determinant.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Apoplexy ; Pituitary ; Transsphenoidal surgery ; Conservative management ; Conservative failure ; Conversion to surgery
Publicat a:	Journal of Clinical and Translational Endocrinology, Vol. 40 (May 2025) , ISSN 2214-6237

DOI: 10.1016/j.jcte.2025.100399
PMID: 40486975

8 p, 895.5 KB

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