Pituitary apoplexy score, toward standardized decision-making: a descriptive study.

Area of Science:

• Endocrinology
• Neurosurgery
• Ophthalmology

Background:

• Pituitary apoplexy (PA) is a rare, severe complication of pituitary adenomas.
• Urgent glucocorticoid treatment is standard; however, the optimal surgical approach remains debated.
• The Pituitary Apoplexy Score (PAS) is a tool to aid in surgical decision-making.

Purpose of the Study:

• To assess variables in surgical versus non-surgical PA patient groups.
• To apply the PAS to establish a significant threshold for surgical intervention.
• To compare ophthalmological and endocrine deficits between groups and identify associated variables.

Main Methods:

• Retrospective study of PA patients from 2003-2022.
• Application of the Pituitary Apoplexy Score (PAS) to surgical and non-surgical groups.
• Multivariate analysis to confirm PAS significance and identify associated variables.

Main Results:

• Significant differences in PAS were observed between conservative (1.7 ± 1.7) and surgical (3.9 ± 1.7) groups (p < 0.0001).
• A PAS threshold of 5 demonstrated over 80% positive predictive value for surgical intervention.
• Low prolactin levels (<5 ng/ml) were associated with higher corticotropic deficiency at 3 months and 1 year (p=0.017, p=0.027).

Conclusions:

• The PAS is a valuable tool for managing pituitary apoplexy.
• A PAS threshold of 5 is proposed to guide surgical decisions.
• Further multicenter studies are needed due to the low incidence of PA.