Hemorrhagic PitNets Are Associated with Previous Vascular Events and Result in Worse Endocrine Outcome

Background: Pituitary apoplexy is a potentially life-threatening condition that most often results from hemorrhage into a preexisting pituitary neuroendocrine tumor (PitNet) presenting with acute headache, visual impairment and endocrine dysfunction. Here, we aimed to identify factors associated with hemorrhage and present the pituitary hormonal status before and after transnasal-transsphenoidal tumor removal in a comparative study design.

Methods: A series of 100 patients with PitNet were analyzed. We compared demographic data (age, sex, BMI), comorbidities, tumor volume and neuropathological findings between patients who presented with hemorrhagic PitNet (H-PitNet) and those with non-hemorrhagic PitNet (NH-PitNet). Furthermore, we compared the axis-specific hormonal status between both groups at admission and after microsurgical tumor removal and analyzed the overall endocrine outcome in both groups.

Results: A total of 22 patients presented with hemorrhagic PitNet. There were no differences in age, sex, BMI, tumor volume, smoking status or diabetes status between patients with H-PitNet and those with NH-PitNet. H-PitNet was strongly associated with necrotic areas (p < 0.0001). Corticotropic PitNet was slightly overrepresented in H-PitNet (p = 0.04). Arterial hypertension was more frequent in patients with H-PitNet (p = 0.009). The presence of hypopituitarism in each axis at admission and after surgery was comparable between the two groups. In total, there were fewer recovering axes (p = 0.03) and more axes with persistent deficiency (p = 0.01) in the H-PitNet group after surgery.

Conclusions: H-PitNet is associated with previous vascular event (ischemia or hemorrhage) and the presence of arterial hypertension and results in worse endocrine outcome. Early surgery should be considered in patients with PitNet and arterial hypertension.