Predictors of conversion to surgery in pituitary apoplexy

Background: Pituitary apoplexy (PA) is a rare but potentially life-threatening condition. While conservative management is an option in selected cases, predictors of conversion to surgery after initial conservative management remain unclear. Objective: To identify predictors of transitioning to surg...

Descripción completa

Detalles Bibliográficos
Autores: Biagetti, Betina|||0000-0002-8837-4343, Cordero Asanza, Esteban|||0000-0003-0464-3014, Pérez-López, Carlos|||0000-0001-7400-4360, Rodríguez Berrocal, Víctor, Vicente, Almudena, Lamas, Cristina|||0000-0003-4622-9508, Guerrero-Pérez, Fernando, Simó-Servat, Andreu|||0000-0002-1092-1327, Serra, Guillermo, Echarri, Ana Irigaray|||0000-0002-5307-1991, Ollero, M.Dolores, González Molero, Inmaculada, Villar-Taibo, Rocío, Moure Rodríguez, María Dolores, García-Feijoo, Pablo|||0000-0002-9052-2421, Sánchez Ramirez, María Noelía, Gutiérrez Hurtado, Alba, Capristan-Díaz, Vanessa, Camara, Rosa, Gallach, Marta, Safont Perez, Eva|||0000-0003-2565-9568, González Rosa, Victoria, Civantos-Modino, Soralla, Martinez-Saez, Elena|||0000-0001-6004-5364, Menéndez Torre, Edelmiro|||0000-0002-9548-7821, Aulinas, Anna|||0000-0002-1205-7114, Iglesias, Pedro|||0000-0003-0126-1985, Diez, Juan J., Bernabeu Morón, Ignacio|||0000-0001-8421-7394, Álvarez-Escolá, Cristina|||0000-0002-4684-1652, Puig Domingo, Manuel|||0000-0002-6744-7195, Araujo-Castro, Marta|||0000-0002-0519-0072
Tipo de recurso: artículo
Fecha de publicación:2025
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:318681
Acceso en línea:https://ddd.uab.cat/record/318681
https://dx.doi.org/urn:doi:10.1016/j.jcte.2025.100399
Access Level:acceso abierto
Palabra clave:Apoplexy
Pituitary
Transsphenoidal surgery
Conservative management
Conservative failure
Conversion to surgery
Descripción
Sumario:Background: Pituitary apoplexy (PA) is a rare but potentially life-threatening condition. While conservative management is an option in selected cases, predictors of conversion to surgery after initial conservative management remain unclear. Objective: To identify predictors of transitioning to surgery in PA who were initially managed conservatively, and to assess the timing and impact of surgical conversion. Methods: This multicenter observational study included 134 patients with PA initially managed conservatively. Patients were categorized into successful conservative management (no surgery or surgery scheduled after 30 days) and conversion to surgery (surgery within 8-30 days). Logistic and Cox regression analyses were performed to identify predictors of conversion to surgery and time to transition, respectively. Results: Among the 134 patients enrolled, the median age was 61.4 years (interquartile range: 16.0) years and 93 (69.4 %) men], 69 (51.5 %) ultimately required surgery, with most transitions occurring within the first two weeks. In logistic regression analysis, larger tumor size (OR: 1.09, 95 % CI: 1.02-1.16) and higher BMI (OR: 1.11, 95 % CI: 1.01-1.22) were independently associated with conversion to surgery. However, Cox regression did not identify any variables predicting time to transition. Additionally, patients who converted to surgery had a significantly longer hospital stay (21.0 vs. 7.5 days, p < 0.01). Conclusion: Half of the patients initially managed conservatively required convertion to surgery. Tumor size and BMI were associated with an increased likelihood of surgery, but no factors predicted when surgery would occur, suggesting that the decision to conversion to surgery may be influenced by multiple clinical factors rather than a single determinant.

Similares en LA Referencia