Differences in clinical profiles of patients with symptomatic and asymptomatic apoplexy in pituitary neuroendocrine tumors.

PURPOSE: Pituitary apoplexy results from hemorrhage and/or infarction of a pituitary neuroendocrine tumor (PitNET). Although characterized by an acute clinical syndrome that includes headache, visual deterioration, and cranial nerve palsies, a subset of cases are "asymptomatic", detected incidentally. No data exists comparing the preoperative characteristics and outcomes of symptomatic and asymptomatic apoplexy. To that end, we aimed to elucidate the differences in clinical profiles of patients with symptomatic and asymptomatic pituitary apoplexy.

METHODS

We retrospectively analyzed all apoplectic PitNETs that presented to us between 2013 and 2023. Preoperative clinical, hematological, and radiological characteristics were compared among symptomatic and asymptomatic cases. Pathological classification was performed on the basis of hormone immunohistochemistry alone, and differences in outcomes were examined between the groups.

RESULTS

The cohort comprised 83 patients, 67 with symptomatic apoplexy 16 with asymptomatic apoplexy. Headache, vomiting and cranial nerve palsies were more frequent among symptomatic apoplexy. Total WBC count and neutrophil:lymphocyte ratio (NLR) were significantly greater among the symptomatic apoplexy group than the asymptomatic apoplexy group (p < 0.001 and 0.030 respectively). Hyponatremia occurred in 42.2 %, more frequent among acute apoplexy, with all cases of moderate-severe hyponatremia due to SIADH and hypocortisolemia. Eight patients developed thrombotic events associated with significantly greater total WBC count and NLR.

CONCLUSIONS

Symptomatic and asymptomatic pituitary apoplexy represent distinct clinical entities. Significantly greater leukocytosis and NLR are associated with symptomatic apoplexy, as well as with thrombotic events in symptomatic apoplexy. Hyponatremia frequently accompanies pituitary apoplexy, especially in symptomatic cases, with SIADH and hypopituitarism causing moderate-severe hyponatremia.