Category: Pituitary Disorders/Neuroendocrinology
Pituitary apoplexy is rare, but may be the first manifestation of an underlying adenoma. In 80% of pituitary apoplexy cases, an underlying adenoma has not been previously diagnosed. Transsphenoidal Surgery (TSS) remains controversial, but is typically required with deterioration of consciousness. Differences in postoperative complication rates based on a prior diagnosis of pituitary adenoma has not been fully studied. We hypothesize that complications following TSS would be higher among patients without prior history of adenoma due to a lower suspicion for pituitary apoplexy. We report on the national trends in pituitary apoplexy requiring TSS and its outcomes in patients with and without a prior diagnosis of pituitary adenoma.
Methods : The National Inpatient Sample (NIS) was utilized from 2012 to 2014. The database was queried for TSS due to pituitary apoplexy both with and without a history of pituitary adenoma. Baseline characteristics, Charlson Co-morbidity Index (CCI), mortality, length of stay, and complications of TSS were compared between the cohorts. Statistical analyses were done using student's t-test, chi-square test, and binary logistic regression with an α level of 0.05.
Results : A total of 4,325 patients were admitted with primary diagnosis of pituitary apoplexy. 21.3% of cases underwent TSS, of which 16.3% had a history of pituitary adenoma. In the adenoma versus non-adenoma group: mean age was 49.2 years vs. 44.9 (p< 0.05), female distribution 36.6% vs. 74.6% (p<0.001), and length of stay 4.10 days vs. 4.18 (p=0.86). The mortality rate was 0% in both groups and the mean CCI was not statistically different. TSS complication rates in adenoma vs. non-adenoma group, respectively, were CSF leak 0% vs. 1.9% (p=0.68), CSF infection 0% in both groups, diabetes insipidus 0% vs. 16.8% (p<0.001), and electrolyte abnormalities 0% vs. 3.2% (p<0.05). After adjusting for possible confounders, total TSS complication rates remained significantly higher in the non-adenoma group (p<0.001).
Our results indicate no significant difference in mean CCI, length of stay, and mortality rate between patients with and without a prior diagnosis of pituitary adenoma. However, some of the postoperative complications are significantly higher in the non-adenoma group. We hypothesize that clinical suspicion for pituitary apoplexy is greater among patients who have a known underlying adenoma, which leads to expeditious treatment and consequently lower complication rates.
In a population of patients with pituitary apoplexy undergoing TSS, postoperative complication rates were higher among patients without a prior history of adenoma.
Yasaman Motlaghzadeh– Internal Medicine Resident, Rutgers-New Jersey Medical School, West Orange, New Jersey
Alana Persaud– Internal Medicine Resident, Rutgers New Jersey Medical School, New Jersey
Lissette Cespedes– Assistant Professor of Medicine, Rutgers New Jersey Medical School, Newark, New Jersey
Internal Medicine Resident
Rutgers-New Jersey Medical School
West Orange, New Jersey
MD-MPH Degree: Tehran University Of Medical Sciences, Internal Medicine Residency: Rutgers- New Jersey Medical School
Internal Medicine Resident
Rutgers New Jersey Medical School, New Jersey
Internal Medicine residency: Rutgers New Jersey Medical School
Assistant Professor of Medicine
Rutgers New Jersey Medical School
Newark, New Jersey
M.D. Degree: Rutgers-New Jersey Medical School; Residency: Internal Medicine, Rutgers-Robert Wood Johnson Medical School; Fellowship: Endocrinology, Diabetes and Metabolism, Rutgers-Robert Wood Johnson Medical School