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

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Abstract

Pituitary apoplexy (PA), a rare and life-threatening complication of pituitary adenomas, prompts urgent glucocorticoid administration. The optimal surgical approach is debated, and the Pituitary Apoplexy Score (PAS) aids decision-making. Our retrospective study (2003–2022) assesses variables in PA patient groups (surgical vs. non-surgical), applying PAS to establish a significant threshold for surgical decisions. Additionally, we aim to compare the rates of ophthalmological and endocrine deficit between both groups and identify any associated variables. PAS discrepancies were observed, with averages of 1.7 ± 1.7 (p < 0.0001) for conservative and 3.9 ± 1.7 (p < 0.0001) for surgical groups, confirmed by multivariate analysis (p = 0.009). A PAS threshold of 5, showing over 80% positive predictive value, was established. Patients with low prolactin levels (< 5 ng/ml) had higher corticotropic deficiency prevalence at 3-month and 1-year follow-ups (p = 0.017 and 0.027). Our study supports PAS as a valuable PA management tool, suggesting potential variable adjustments. Multicenter studies are crucial due to PA’s low incidence.

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No datasets were generated or analysed during the current study.

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Acknowledgements

The authors thank the patients for contributing to this study.

Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

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Authors and Affiliations

  1. Neurosurgery, CHU Limoges, Limoges, France

    Henri Salle

  2. CAPTuR, Inserm, University of Limoges, CHU Limoges, Limoges, France

    Henri Salle

  3. Endocrinology, CHU Limoges, Limoges, France

    Mathilde Cane, Marie-Pierre Teissier & Laurence Salle

  4. Ophthalmology, CHU Limoges, Limoges, France

    Maxime Rocher

  5. Inserm U1094, IRD U270, EpiMaCT, University of Limoges, CHU Limoges, Limoges, France

    Emilie Auditeau & Laurence Salle

  6. Endocrinology, Hospices Civils de Lyon and Lyon 1 University, Lyon, France

    Gerald Raverot

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Contributions

H.S: wrote the main manuscript, made analysis, and interpretation of data, made substantial contributions to the conception or design of the work. M.C: made the acquisition, analysis, and interpretation of data. M.R: made the acquisition, analysis, and interpretation of data. E.A: made the statistical analysis F.C: approved the version to be published. MP.T: approved the version to be published. G.R: approved the version to be published and drafted the work or revised it critically for important intellectual contentL.S drafted the work or revised it critically for important intellectual content, made the acquisition, analysis, and interpretation of data.

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Correspondence to Henri Salle.

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Salle, H., Cane, M., Rocher, M. et al. Pituitary apoplexy score, toward standardized decision-making: a descriptive study. Pituitary 27, 77–87 (2024). https://doi.org/10.1007/s11102-023-01372-x

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