Age-related differences in the clinical features and management of pituitary apoplexy: a cohort study

Abstract

Background: Pituitary apoplexy (PA) is a rare and acute condition resulting from hemorrhage or infarction of the pituitary gland. This study aimed to assess clinical characteristics, management, and outcomes of PA in patients aged <65 and ≥65 years using data from a Spanish multicenter cohort.

Methods: We conducted a retrospective, multicenter study (2010-2023) of 301 PA patients from 18 Spanish hospitals. Data were analyzed for differences in demographics, clinical presentation, treatment approach, and outcomes.

Results: Patients aged ≥65 years (n = 116, 38.5%) had more comorbidities, compared to younger patients (n = 185, 61.5%). No significant differences were observed in clinical presentation, including PA Score and radiological findings except for higher frequency of cranial nerve palsy (46.2 vs. 64.9%; P = .02) in older patients. Surgical (n = 209), and conservative (n = 92) treatment rates were similar between groups (conservative: 29.9 younger vs. 32.8% older; P = .51). Histopathological analysis revealed more necrosis in patients aged ≥65 years (66.7 vs. 80.6%; P = .04). Surgical resection rates and outcomes including mortality were comparable across age groups.

Conclusions: PA management and outcomes were comparable in younger and older patients, despite greater comorbidities and more severe symptoms in older individuals. Histopathological findings suggest potential age-related differences in tumor biology, warranting further research. MRI would be preferred for diagnosis, particularly in older patients, as ischemic necrotic PA may be undiagnosed without advanced imaging.

Keywords: apoplexy; conservative management; elderly; older individuals; pituitary; surgery.