Pituitary apoplexy is a rare but potentially life-threatening condition caused by hemorrhage or infarction of the pituitary gland. Currently, there is still a lack of consensus in its optimal management. This study aims to describe the baseline characteristics of patients with pituitary apoplexy in our locality, to evaluate their clinical and endocrine outcomes, and to compare the results of conservative and surgical management.

This is a retrospective study performed at three local hospitals in Hong Kong. Patients with pituitary apoplexy diagnosed between April 2000 and April 2022, either treated surgically or conservatively, were recruited. The demographics, presenting symptoms, radiological features, operation records, pathology reports and outcomes were reviewed and analyzed.

Seventy-nine patients were included. The mean age at diagnosis was 53.2 years (SD ±14.5 years, range: 26 – 87 years), with fifty males (63.3%) and twenty-nine females (36.7%). Sixty-four patients (81.0%) were managed surgically and fifteen patients (19.0%) were managed conservatively. Headache was the most common presenting symptom. Fifty-five patients (70.5%) had at least one pituitary hormone deficiency at diagnosis, with gonadotropin deficiency being the most common. The rates of complete recovery from visual acuity deficits (84.6%), visual field deficits (73.1%) and cranial nerve palsies (87.5%) showed no statistically significant differences between the surgically and conservatively managed groups (p=0.214, p=0.974 and p=0.358 respectively). At one–year follow up, fifty-one patients (64.6%) developed at least one pituitary hormone deficiency of new onset.

In patients with pituitary apoplexy in our locality, there was a good recovery of visual symptoms but not endocrine function, regardless of the treatment modality. There was no evidence that patients managed surgically had a better outcome. Early surgical intervention may not be necessary in most patients presenting with pituitary apoplexy.