Biagetti Betina, Cordero Asanza Esteban, García-Feijoo Pablo, Araujo-Castro Marta, Rodríguez Berrocal Víctor, Serra Guillermo, Guerrero-Pérez Fernando, Cámara Rosa, Lamas Cristina, Ollero García M Dolores, Vicente Almudena, Irigaray Echarri Ana, Villar-Taibo Rocío, Moure Rodríguez María Dolores, Pérez-López Carlos, González-Molero Inmaculada, Sánchez Ramírez María Noelia, Gutiérrez Hurtado Alba, Capristan-Díaz Vanessa, Simó-Servat Andreu, Gallach Marta, Safont Pérez Eva, González Rosa Victoria, Civantos Soralla, Martinez-Saez Elena, García-Arabehety Julia, Menéndez Torre Edelmiro, Aulinas Anna, Iglesias Pedro, Díez Juan J, Bernabéu Ignacio, Álvarez-Escolá Cristina, Puig-Domingo Manel
Endocrinology & Nutrition Department, Hospital Universitario Vall d'Hebrón, CIBERER U747 (ISCIII), ENDO-ERN, Universitat Autónoma de Barcelona, Barcelona , Spain.
Neurosurgery Department, Hospital Universitario Vall d'Hebrón, Departament de Cirurgia i Ciències Morfològiques, Universitat Autónoma de Barcelona, Barcelona , Spain.
Neurosurgery. 2024 Dec 5;97(1):82-90. doi: 10.1227/neu.0000000000003281.
Currently, 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.
Spanish multicenter, retrospective study. Statistical analyses compared clinical presentation and outcomes between periods, adjusting for confounders.
A 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.
Although 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.
目前，垂体卒中（PA）的管理已朝着更保守的方法发展，特别是对于PA评分较低的患者。我们的目的是研究PA管理的趋势，比较2017年前后的临床表现、治疗方法和结果，并评估保守治疗患者的长期结果。
西班牙多中心回顾性研究。统计分析比较了不同时期的临床表现和结果，并对混杂因素进行了调整。
共纳入215例PA和无功能垂体腺瘤患者，中位年龄62.2岁，男性患者占68.4%。其中94例（43.7%）在2017年前确诊，121例（56.3%）在2017年或之后确诊。保守治疗从之前的17%增加到最近的30.6%（比值比0.47，95%置信区间0.24 - 0.90，P = 0.02）。在调整医院、年龄和克诺斯普分级后，这一趋势仍然显著（比值比0.46，95%置信区间0.22 - 0.89，P = 0.03）。然而，手术仍然是两个时期最常用的治疗选择。不同时期3个月时的结果无统计学显著差异。在两个时期，手术与保守治疗相比，永久性精氨酸加压素缺乏的发生率更高（2017年前为0 vs 17.9%，P = 0.07；之后为0 vs 16.7%，P = 0.01）。高达89.7%接受保守治疗的患者出现超过25%的肿瘤自发缩小，74.4%的患者肿瘤缩小超过50%。
尽管近年来保守治疗有所增加，但手术仍然是主要选择。接受保守治疗的患者永久性精氨酸加压素缺乏的风险较低，并且随着时间的推移，很大一部分患者的肿瘤出现了具有临床意义的缩小。
