Differences in clinical course between pituitary apoplexy and non-apoplexy patients with nonfunctioning pituitary neuroendocrine tumors

Although the imaging diagnosis of pituitary apoplexy has been well reported, research on the clinical symptoms of this condition remains scarce. This study aimed to provide an accurate clinical evidence of patients with pituitary apoplexy. This retrospective study used data from 311 patients with nonfunctioning pituitary neuroendocrine tumors treated with initial transsphenoidal surgery. Pituitary apoplexy was defined as the presence of acute headache or visual impairment along with a tumor with pathological findings of necrotic changes and/or diffuse hemorrhage. To alleviate the effect of tumor volume and patient sex, propensity score matching was performed between the pituitary apoplexy (APO) and non-apoplexy (non-APO) groups. A total of 20 patients were matched to each of the two groups, and their data were statistically compared. Compared with the non-APO group, the APO group had higher preoperative body temperature (degrees Celsius) and lower levels of preoperative serum sodium (mEq/L) and prolactin (ng/mL). Receiver operating characteristic curve analysis revealed that the optimal prolactin level that supports the diagnosis of pituitary apoplexy was 7.5 ng/mL (AUC = 0.75250, 50% sensitivity, 100% specificity). The patients in the APO group were further divided into two subgroups, those who were evaluated within 3 days of onset and those who were evaluated after 3 days of onset, and the former subgroup was found to have lower serum PRL and sodium level as well as higher body temperature. Hyperthermia, hyponatremia, and hypoprolactinemia indicate the possibility of pituitary apoplexy.Trial number: E-2020-2022, June 1, 2022, retrospectively registered.