Abstract：
OBJECTIVE: To identify clinical and radiological factors associated with a higher risk of developing a severe pituitary apoplexy (PA).
METHODS: Multicenter retrospective study of patients presenting with clinical PA in three Spanish tertiary hospitals of Madrid between 2008 and 2022. We classified PA as severe when presenting with an altered level of consciousness (Glasgow Coma Scale (GCS) < 15) or visual involvement.
RESULTS: A total of 71 PA cases were identified, of whom 80.28% (n = 57) were classified as severe PA. The median age was 60 (18 to 85 years old) and 67.6% (n = 48) were male. Most patients had macroadenomas, except for one patient with a microadenoma of 9 mm. Headache was the most common presenting symptom (90.1%) and anticoagulation was the most frequent predisposing risk factor, but it was not associated with a higher risk for severe PA (odds ratio [OR] 1.13 [0.21-5.90]). Severe cases were associated with male gender (OR 5.53 [1.59-19.27]), tumor size >20 mm (OR 17.67 [4.07-76.64]), and Knosp grade ≥2 (OR 9.6 [2.38-38.73]). In the multivariant analysis, the only variables associated with a higher risk for severe PA were tumor size and Knosp grade. Surgery was more common in severe PA than in non-severe (91.2% vs. 64.3%, P = 0.009).
CONCLUSIONS: A tumor size >20 mm and cavernous sinus invasion are risk factors for developing a severe PA. These risk factors can stratify patients at a higher risk of a worse clinical picture, and subsequently, more need of decompressive surgery.
METHODS: Multicenter retrospective study of patients presenting with clinical PA in three Spanish tertiary hospitals of Madrid between 2008 and 2022. We classified PA as severe when presenting with an altered level of consciousness (Glasgow Coma Scale (GCS) < 15) or visual involvement.
RESULTS: A total of 71 PA cases were identified, of whom 80.28% (n = 57) were classified as severe PA. The median age was 60 (18 to 85 years old) and 67.6% (n = 48) were male. Most patients had macroadenomas, except for one patient with a microadenoma of 9 mm. Headache was the most common presenting symptom (90.1%) and anticoagulation was the most frequent predisposing risk factor, but it was not associated with a higher risk for severe PA (odds ratio [OR] 1.13 [0.21-5.90]). Severe cases were associated with male gender (OR 5.53 [1.59-19.27]), tumor size >20 mm (OR 17.67 [4.07-76.64]), and Knosp grade ≥2 (OR 9.6 [2.38-38.73]). In the multivariant analysis, the only variables associated with a higher risk for severe PA were tumor size and Knosp grade. Surgery was more common in severe PA than in non-severe (91.2% vs. 64.3%, P = 0.009).
CONCLUSIONS: A tumor size >20 mm and cavernous sinus invasion are risk factors for developing a severe PA. These risk factors can stratify patients at a higher risk of a worse clinical picture, and subsequently, more need of decompressive surgery.
摘要：
目的：确定与发生严重垂体卒中（PA）的高风险相关的临床和放射学因素。
方法：2008年至2022年在马德里的三家西班牙三级医院进行临床PA患者的多中心回顾性研究。当出现意识水平改变（格拉斯哥昏迷量表（GCS）<15）或视觉受累时，我们将PA分类为严重。
结果：共确定了71例PA病例，其中80.28%(n=57)被归类为重度PA。中位年龄为60岁（18至85岁），男性占67.6％（n=48）。大多数患者有大型腺瘤，除了一个9毫米的微腺瘤患者。头痛是最常见的症状（90.1%），抗凝是最常见的诱发危险因素。但与重度PA的高风险无关(比值比[OR]1.13[0.21-5.90]).严重病例与男性相关（OR5.53[1.59-19.27]），肿瘤大小>20毫米（OR17.67[4.07-76.64]），和Knosp等级≥2（OR9.6[2.38-38.73]）。在多变量分析中，与重度PA高风险相关的唯一变量是肿瘤大小和Knosp分级.重度PA手术比非重度PA手术更常见（91.2%vs.64.3%,P=0.009)。
结论：肿瘤大小>20mm和海绵窦浸润是发生重度PA的危险因素。这些风险因素可以将患者分层，使其具有更高的临床表现风险，随后,更需要减压手术。
方法：2008年至2022年在马德里的三家西班牙三级医院进行临床PA患者的多中心回顾性研究。当出现意识水平改变（格拉斯哥昏迷量表（GCS）<15）或视觉受累时，我们将PA分类为严重。
结果：共确定了71例PA病例，其中80.28%(n=57)被归类为重度PA。中位年龄为60岁（18至85岁），男性占67.6％（n=48）。大多数患者有大型腺瘤，除了一个9毫米的微腺瘤患者。头痛是最常见的症状（90.1%），抗凝是最常见的诱发危险因素。但与重度PA的高风险无关(比值比[OR]1.13[0.21-5.90]).严重病例与男性相关（OR5.53[1.59-19.27]），肿瘤大小>20毫米（OR17.67[4.07-76.64]），和Knosp等级≥2（OR9.6[2.38-38.73]）。在多变量分析中，与重度PA高风险相关的唯一变量是肿瘤大小和Knosp分级.重度PA手术比非重度PA手术更常见（91.2%vs.64.3%,P=0.009)。
结论：肿瘤大小>20mm和海绵窦浸润是发生重度PA的危险因素。这些风险因素可以将患者分层，使其具有更高的临床表现风险，随后,更需要减压手术。
