TY - JOUR
T1 - Towards a pituitary apoplexy classification based on clinical presentation and patient journey
AU - Guijt, M. C.
AU - Zamanipoor Najafabadi, A. H.
AU - Notting, I. C.
AU - Pereira, A. M.
AU - Verstegen, M. J. T.
AU - Biermasz, N. R.
AU - van Furth, W. R.
AU - Claessen, K. M. J. A.
N1 - Funding Information: We would like to thank M.S. Zuurmond, MA, with her help with the illustration of Figs. 1 , 2 , 3 , and 4. Publisher Copyright: © 2022, The Author(s).
PY - 2022/4/1
Y1 - 2022/4/1
N2 - Purpose: The condition of pituitary apoplexia contains the clinical spectre from life-threatening emergency to asymptomatic self-limiting course, which partly determines diagnostic delay and management. Outcome evaluation of course and management of pituitary apoplexia is hampered by the diverse presentation of this condition and requires appraisal. This study aimed to describe the patient journey, clinical presentation, and management of various types of pituitary apoplexy in a new classification to facilitate future outcome evaluation and identify unmet needs in the care process. Methods: A single-center retrospective patient chart study was conducted between 2005–2021 (N = 98). Outcome measures were clinical symptoms at first presentation in hospital, being headache, consciousness, visual acuity, visual field defects (VFD), ophthalmoplegia, nausea, vomiting, fever, and hypopituitarism and care process characteristics. Results: Mean age was 47.6 ± 16.6 years (51.0% male). We describe their patient journey and identified three different types, differing in clinical presentation, in-hospital route, and final treatment, e.g., Acute (type A, 52%), Subacute (type B, 22.5%), and Non-acute (type C, 25.5%). Type A generally presents with acute onset headaches, VFD, or ophthalmoplegia emergency setting, with lowest mean visual acuity of both eyes and frequent hypocortisolism. Conclusions: Pituitary apoplexy can be approached as a spectrum of disease with 3 main subtypes, with a different initial presentation, different in-hospital route resulting in different management. Acknowledging subtypes with particular needs for (emergency) referrals to Pituitary Tumors Center of Excellence (PTCOE) will serve patient care improvements, outcome evaluations and address areas for improvement.
AB - Purpose: The condition of pituitary apoplexia contains the clinical spectre from life-threatening emergency to asymptomatic self-limiting course, which partly determines diagnostic delay and management. Outcome evaluation of course and management of pituitary apoplexia is hampered by the diverse presentation of this condition and requires appraisal. This study aimed to describe the patient journey, clinical presentation, and management of various types of pituitary apoplexy in a new classification to facilitate future outcome evaluation and identify unmet needs in the care process. Methods: A single-center retrospective patient chart study was conducted between 2005–2021 (N = 98). Outcome measures were clinical symptoms at first presentation in hospital, being headache, consciousness, visual acuity, visual field defects (VFD), ophthalmoplegia, nausea, vomiting, fever, and hypopituitarism and care process characteristics. Results: Mean age was 47.6 ± 16.6 years (51.0% male). We describe their patient journey and identified three different types, differing in clinical presentation, in-hospital route, and final treatment, e.g., Acute (type A, 52%), Subacute (type B, 22.5%), and Non-acute (type C, 25.5%). Type A generally presents with acute onset headaches, VFD, or ophthalmoplegia emergency setting, with lowest mean visual acuity of both eyes and frequent hypocortisolism. Conclusions: Pituitary apoplexy can be approached as a spectrum of disease with 3 main subtypes, with a different initial presentation, different in-hospital route resulting in different management. Acknowledging subtypes with particular needs for (emergency) referrals to Pituitary Tumors Center of Excellence (PTCOE) will serve patient care improvements, outcome evaluations and address areas for improvement.
KW - Acute
KW - Classification system
KW - Pituitary apoplexy
KW - Spectrum of disease
KW - Sub-acute and non-acute
UR - http://www.scopus.com/inward/record.url?scp=85123488844&partnerID=8YFLogxK
U2 - https://doi.org/10.1007/s12020-022-02983-3
DO - https://doi.org/10.1007/s12020-022-02983-3
M3 - Article
C2 - 35067902
SN - 1355-008X
VL - 76
SP - 132
EP - 141
JO - ENDOCRINE
JF - ENDOCRINE
IS - 1
ER -