Related Experiment Video
Updated: Nov 21, 2025
Endoscopic Endonasal Trans-sphenoidal Approach: Minimally Invasive Surgery for Pituitary Adenomas
Published on: January 17, 2018
Outcomes of pituitary apoplexy: a comparison of microadenomas and macroadenomas
Afif Nakhleh1, Mai Assaliya Naffa2, Gill Sviri3,4
1Institute of Endocrinology, Diabetes and Metabolism, Rambam Health Care Campus, HaAliya HaShniya Street 8, 3109601, Haifa, Israel. anakhleh@gmail.com.
Purpose:
We aimed to assess clinical characteristics of apoplexy of pituitary microadenomas compared to macroadenomas.
Methods:
We retrieved clinical records of patients > 18 years old, hospitalized in Rambam hospital between January 2001 and October 2017, with pituitary apoplexy and follow-up of at least one year. We compared clinical course and outcomes of apoplexy between patients with microadenomas and macroadenomas, and between patients who received conservative or surgical treatment. Statistical analysis was done using Fisher's exact and Mann-Whitney tests.
Results:
Twenty-seven patients with pituitary apoplexy were included in the final analysis: mean age was 40.7 ± 12.5 years, 13(48%) were female, 7(26%) had microadenomas, and 21(78%) harbored clinically nonfunctioning pituitary adenomas. Upon admission, hyponatremia, random cortisol level of < 200 nmol/L, and secondary hypothyroidism, were evident in 6/20, 8/18, and 4/18 patients with macroadenoma and 1/5, 2/5, and 1/6 patients with microadenoma, respectively (P = 1.0). Hypogonadotropic hypogonadism was evident in 9/12 men with macroadenoma. In 12 macroadenoma patients, the tumor abutted the optic chiasm, of whom eight had visual field defects. Fifteen patients with macroadenoma and two with microadenoma underwent transsphenoidal surgery. Median follow-up was 3 years. At last follow-up visit, patients with microadenoma had lower rates of corticotropic deficiency or secondary hypothyroidism compared to macroadenoma patients (1/7 vs. 13/20 respectively, p = 0.033). Only two patients with macroadenomas had persistent visual field defects. Outcomes were comparable between conservative and surgical treatment groups.
Conclusions:
Long term pituitary hormone deficiencies are more common in pituitary apoplexy patients with macroadenomas. Apoplexy of pituitary microadenoma carries a more favorable prognosis.
Insights
Pituitary apoplexy in microadenomas has a better long-term outcome than in macroadenomas, with fewer hormone deficiencies. This study compared clinical features and prognosis of pituitary apoplexy between microadenomas and macroadenomas.
Area of Science:
- Endocrinology
- Neurosurgery
- Clinical Medicine
Background:
- Pituitary apoplexy is a medical emergency.
- It can occur in both pituitary microadenomas and macroadenomas.
- Understanding differences in clinical presentation and outcomes is crucial for patient management.
Purpose of the Study:
- To compare the clinical characteristics and outcomes of pituitary apoplexy in patients with microadenomas versus macroadenomas.
- To evaluate the impact of tumor size on the clinical course and long-term pituitary function after apoplexy.
Main Methods:
- Retrospective review of patients (age >18) with pituitary apoplexy hospitalized between 2001-2017.
- Comparison of clinical features, treatment (conservative vs. surgical), and outcomes between microadenoma and macroadenoma groups.
- Statistical analysis using Fisher's exact and Mann-Whitney tests.
Main Results:
- Twenty-seven patients were analyzed; 7 had microadenomas and 20 had macroadenomas.
- Long-term pituitary hormone deficiencies were significantly more common in macroadenoma patients (13/20) compared to microadenoma patients (1/7).
- Outcomes were similar between conservative and surgical treatment groups, with only two macroadenoma patients experiencing persistent visual field defects.
Conclusions:
- Pituitary apoplexy associated with macroadenomas leads to a higher incidence of long-term pituitary hormone deficiencies.
- Microadenoma apoplexy presents a more favorable prognosis regarding pituitary function recovery.
