Pituitary apoplexy in cushing’s disease: a single center study and systematic literature review
Authors' conclusion
PA in CD is more commonly associated with macroadenomas, may present with hypocortisolemia, and surgical treatment tends towards higher and longer-lasting remission rates.
Study context
- Population
- Patients with pituitary apoplexy in Cushing's disease (CD), managed at one centre 1987–2023 plus cases from systematic review12 centre, 46 review
- Participants
- 58 patients
- Outcome
- Characteristics of PA in CD
Main finding
As reported in the abstract
- Females
- 44
- Pituitary apoplexy (PA) prevalence in CD at centre (12/315)
- 3.8%
- Median age at PA diagnosis
- 35 years
- Type A presentation
- 79.3%
- Headache
- 89.6%
- Median Pituitary Apoplexy Score
- 2
- Median cortisol
- 24.9 µg/dl
- Median ACTH
- 94.1 pg/ml
- Apoplexy as first manifestation of CD
- 55.2%
- Hypocortisolemia at presentation (serum cortisol ≤ 5.0 µg/dl) (14/45)
- 31.1%
- Median largest tumor dimension
- 1.7 cm
- Macroadenomas
- 53/58
- Managed surgically
- 57.8%
Observational data: associations, not effects.
Further findings
Microadenoma cases: remission with conservative management
- All PA cases with microadenoma achieved remission through conservative management
- 5
- Later relapsed
- 2
Treatment-naïve CD with macroadenoma: surgical vs conservative
- Remained in remission longer, surgical vs conservative (p = 0.07)
- 70% vs. 38.5%
- Average remission duration, surgical vs conservative
- 31 vs. 10.5 months
- PA-related neuro-deficit improvement comparable between surgical and conservative groups
Original publication
Pituitary apoplexy in cushing’s disease: a single center study and systematic literature review. Pituitary. Published 8 June 2024. doi:10.
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