Epidemiology, presentation and outcomes in pituitary apoplexy: a population-based study in Malta

To determine the prevalence, incidence, and outcomes of pituitary apoplexy patients presenting acutely in Malta.

Twenty-nine patients presenting with pituitary apoplexy between 1980 and 2023 were retrospectively identified. The prevalence and incidence rates were calculated. The clinical presentation, endocrinological and radiological findings, and outcomes of all patients with pituitary apoplexy were analysed and compared between the two cohorts who were treated conservatively or with early surgical intervention, taking into consideration serum prolactin levels at diagnosis. The pituitary apoplexy score was applied retrospectively.

Five of the 29 patients had a known pituitary adenoma. The prevalence for pituitary apoplexy was 4.61/100,000 individuals (NFPA 3.69/100,000; functional adenoma 0.92/100,000), and the overall SIR was 0.189/100,000/year (NFPA 0.144/100,000/year; functional adenoma 0.047/100,000/year). Prevalence rates and SIR were higher among males (prevalence 8.08/100,000 in males vs 0.78/100,000 in females). Ninety-two percent of the patients who presented with apoplexy were macroadenomas, while 8% were microadenomas. The median age for apoplexy was found to be 51 years (42-58); higher in the NFPA subtype, 55 (49.5-63) when compared to 43 (38.5-45.25) in the functional group. Visual field defects were more prevalent when baseline prolactin levels were less than 5 ng/mL, 68.75 vs 42.86% (P = 0.014). There was no difference in terms of endocrinological outcome at 3 or 12 months between the surgically and conservatively treated groups.

Through thorough case identification, this study provides both prevalence and incidence rates of pituitary apoplexy in a well-defined population in Malta. Clinical sequelae and various treatment modalities have been studied to better understand this rare condition.