Recurrent pituitary apoplexy: experience from a national registry and review of the literature
Background: Pituitary apoplexy (PA) is a neuroendocrine emergency characterized by acute hemorrhage or infarction of a pituitary adenoma. While its initial presentation and management are well documented, data on recurrent PA remain scarce.Objectives: To determine the prevalence, clinical characteri...
| Autores: | , , , , , , , , , |
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| Tipo de recurso: | artículo |
| Estado: | Versión publicada |
| Fecha de publicación: | 2026 |
| País: | España |
| Institución: | Institut d’Investigació Biomèdica Sant Pau (IIB Sant Pau) |
| Repositorio: | r-IIB SANT PAU. Repositorio Institucional de Producción Científica del Instituto de Investigación Biomédica Sant Pau |
| OAI Identifier: | oai:dnet:r-iibsantpa_::62f58439219596452b9ac7597071c0bd |
| Acceso en línea: | https://iibsantpau.fundanetsuite.com/Publicaciones/ProdCientif/PublicacionFrw.aspx?id=21367 |
| Access Level: | acceso abierto |
| Palabra clave: | apoplexy conservative pituitary recurrent risk factors surgery |
| Sumario: | Background: Pituitary apoplexy (PA) is a neuroendocrine emergency characterized by acute hemorrhage or infarction of a pituitary adenoma. While its initial presentation and management are well documented, data on recurrent PA remain scarce.Objectives: To determine the prevalence, clinical characteristics, and predictors of recurrent PA in a national cohort, and to contextualize findings through a structured review of the literature.Design: Multicenter retrospective cohort study complemented by a structured literature review.Methods: We analyzed 274 patients from the Spanish Pituitary Apoplexy Registry (2010-2023) with complete follow-up. Recurrent PA was defined as a new acute episode with radiological evidence of hemorrhage or infarction within a previously affected lesion. Clinical, radiological, and treatment-related variables were compared between recurrent and non-recurrent cases. A complementary literature review identified published reports of recurrence.Results: Recurrent PA occurred in 9 patients (3.3%), including 6 of 214 with nonfunctioning adenomas (2.8%) and 3 of 60 with functioning adenomas (5.0%). Compared with nonrecurrent cases, patients with recurrence had significantly larger tumors (median 35 vs 25 mm; p = 0.006), higher rates of cavernous sinus invasion (77.9% vs 37.3%; p = 0.006), and more frequent prior cabergoline therapy (33.3% vs 6.3%; p = 0.020). Median time to recurrence was 18 months (range, 2-108). The literature review identified 11 studies reporting recurrence rates of 2.6%-16.7%, with more consistent estimates (4%-9.6%) in larger series (n >= 50). All recurrent cases showed a favorable clinical course and recovery.Conclusion: Recurrent PA is uncommon, affecting approximately 3% of patients with a prior apoplexy episode. Given the low frequency of recurrence, the associated factors identified should be interpreted cautiously and considered primarily hypothesis-generating. The second episode was not more severe than the initial event, and the long-term prognosis was favorable.Trial registration: Not applicable. |
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