Pituitary apoplexy – an urgent operation or a wait-and-see strategy?

Background. Pituitary tumors are a common pathology in neuro-oncology. They constitute 10 % of all intracranial tumors; and for a long time, they may not have any clinical manifestations. In situations where pituitary apoplexy is the first manifestation of the disease, the choice of optimal tactics is particularly relevant. Considering cases of spontaneous tumor resorption after pituitary apoplexy, the standard approach to this pathology as an exceptional urgent one requires revision.

Aim. To review the treatment strategy of patients with pituitary apoplexy, identifying factors contributing to both tumor resorption and achievement of a better clinical result. After specification of the indications for surgery, to create an algorithm for treating patients with pituitary apoplexy.

Materials and methods. The paper analyzes the results of treatment of 82 patients with pituitary apoplexy. Only 45 patients were operated on. In 37 patients, the need for surgery ceased during preparation.

Results. Analysis of treatment results of 82 patients with pituitary apoplexy identified optimal tumor parameters and radiological characteristics for which the probability of spontaneous resorption is the highest: 89.2 % (33 out of 37) cases. The use of dexamethasone as part of therapy has shown to play a key role in achieving optimal results. The analysis of the data allowed us to formulate criteria for which a wait-and-see tactic in pituitary apoplexy can provide a result comparable to the surgical method of treatment and even surpassing it in terms of preservation of pituitary functions.

Conclusion. As a result of the study, an algorithm for treatment of patients with pituitary apoplexy was proposed. The application of the proposed algorithm will allow, in some cases, to forego an emergency surgery and obtain a comparable clinical result with less risk for the patient.

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