Comparing neuroendocrine recovery between surgical and conservative management in pituitary apoplexy patients: a propensity score-matched analysis

Abstract

Background: Pituitary apoplexy is a rare and potentially life-threatening clinical syndrome. Patients may present with severe neuro-ophthalmologic or endocrine symptoms. Current evidence is unclear whether conservative or surgical management leads to the best neuroendocrine outcomes. This study aimed to compare neuroendocrine outcomes between surgical and conservative treatments in a single center. Methods: Cases of patients with pituitary apoplexy who received transsphenoidal surgery or conservative management in Songklanagarind Hospital between January 1, 2005 and December 31, 2022 were retrospectively reviewed. A propensity score matching method was used to adjust bias from treatment selection (surgery or conservative treatment). Differences in visual acuity, visual eld, cranial nerve, and endocrine outcomes between the surgical and conservative treatment groups were analyzed using logistic regression analysis.Results: This study included 127 patients, with 98 and 29 patients in the surgical and the conservative treatment group, respectively. The optimal matching method was used for propensity score matching.Compared to the conservative group, the surgically treated patients had a signi cantly higher rate of visual eld recovery (odds ratio (OR): 12.89, P = 0.007). However, there were no statistical differences in the recovery rate of preoperative visual acuity, cranial nerve, and endocrine de cits between the groups.Conclusions: Transsphenoidal surgery was associated with a higher rate of visual eld recovery when compared to the conservative treatment for pituitary apoplexy patients. Careful selection of appropriate treatment based on the patient's presentation and neuroendocrine status will result in the best outcomes while avoiding unnecessary surgical intervention.