Differences in clinical profiles of patients with symptomatic and asymptomatic apoplexy in pituitary neuroendocrine tumors

IF 1.8 4区医学 Q3 CLINICAL NEUROLOGY

Journal of Clinical Neuroscience Pub Date : 2025-09-15 DOI:10.1016/j.jocn.2025.111625

Abhijit Goyal-Honavar , Subhas Konar , Nishanth Sadashiva , Shilpa Rao , Mohammed Nadeem , A.R. Prabhu Raj , Jitendra Saini , A. Arivazhagan , Dwarkanath Srinivas , Dhaval Shukla

{"title":"Differences in clinical profiles of patients with symptomatic and asymptomatic apoplexy in pituitary neuroendocrine tumors","authors":"Abhijit Goyal-Honavar , Subhas Konar , Nishanth Sadashiva , Shilpa Rao , Mohammed Nadeem , A.R. Prabhu Raj , Jitendra Saini , A. Arivazhagan , Dwarkanath Srinivas , Dhaval Shukla","doi":"10.1016/j.jocn.2025.111625","DOIUrl":null,"url":null,"abstract":"<div><h3>Purpose</h3><div>Pituitary apoplexy results from hemorrhage and/or infarction of a pituitary neuroendocrine tumor (PitNET). Although characterized by an acute clinical syndrome that includes headache, visual deterioration, and cranial nerve palsies, a subset of cases are “asymptomatic”, detected incidentally. No data exists comparing the preoperative characteristics and outcomes of symptomatic and asymptomatic apoplexy. To that end, we aimed to elucidate the differences in clinical profiles of patients with symptomatic and asymptomatic pituitary apoplexy.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed all apoplectic PitNETs that presented to us between 2013 and 2023. Preoperative clinical, hematological, and radiological characteristics were compared among symptomatic and asymptomatic cases. Pathological classification was performed on the basis of hormone immunohistochemistry alone, and differences in outcomes were examined between the groups.</div></div><div><h3>Results</h3><div>The cohort comprised 83 patients, 67 with symptomatic apoplexy 16 with asymptomatic apoplexy. Headache, vomiting and cranial nerve palsies were more frequent among symptomatic apoplexy. Total WBC count and neutrophil:lymphocyte ratio (NLR) were significantly greater among the symptomatic apoplexy group than the asymptomatic apoplexy group (<em>p < 0.001</em> and <em>0.030</em> respectively). Hyponatremia occurred in 42.2 %, more frequent among acute apoplexy, with all cases of moderate-severe hyponatremia due to SIADH and hypocortisolemia. Eight patients developed thrombotic events associated with significantly greater total WBC count and NLR.</div></div><div><h3>Conclusions</h3><div>Symptomatic and asymptomatic pituitary apoplexy represent distinct clinical entities. Significantly greater leukocytosis and NLR are associated with symptomatic apoplexy, as well as with thrombotic events in symptomatic apoplexy. Hyponatremia frequently accompanies pituitary apoplexy, especially in symptomatic cases, with SIADH and hypopituitarism causing moderate-severe hyponatremia.</div></div>","PeriodicalId":15487,"journal":{"name":"Journal of Clinical Neuroscience","volume":"141 ","pages":"Article 111625"},"PeriodicalIF":1.8000,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Clinical Neuroscience","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S0967586825005983","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q3","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Purpose

Pituitary apoplexy results from hemorrhage and/or infarction of a pituitary neuroendocrine tumor (PitNET). Although characterized by an acute clinical syndrome that includes headache, visual deterioration, and cranial nerve palsies, a subset of cases are “asymptomatic”, detected incidentally. No data exists comparing the preoperative characteristics and outcomes of symptomatic and asymptomatic apoplexy. To that end, we aimed to elucidate the differences in clinical profiles of patients with symptomatic and asymptomatic pituitary apoplexy.

Methods

We retrospectively analyzed all apoplectic PitNETs that presented to us between 2013 and 2023. Preoperative clinical, hematological, and radiological characteristics were compared among symptomatic and asymptomatic cases. Pathological classification was performed on the basis of hormone immunohistochemistry alone, and differences in outcomes were examined between the groups.

Results

The cohort comprised 83 patients, 67 with symptomatic apoplexy 16 with asymptomatic apoplexy. Headache, vomiting and cranial nerve palsies were more frequent among symptomatic apoplexy. Total WBC count and neutrophil:lymphocyte ratio (NLR) were significantly greater among the symptomatic apoplexy group than the asymptomatic apoplexy group (p < 0.001 and 0.030 respectively). Hyponatremia occurred in 42.2 %, more frequent among acute apoplexy, with all cases of moderate-severe hyponatremia due to SIADH and hypocortisolemia. Eight patients developed thrombotic events associated with significantly greater total WBC count and NLR.

Conclusions

Symptomatic and asymptomatic pituitary apoplexy represent distinct clinical entities. Significantly greater leukocytosis and NLR are associated with symptomatic apoplexy, as well as with thrombotic events in symptomatic apoplexy. Hyponatremia frequently accompanies pituitary apoplexy, especially in symptomatic cases, with SIADH and hypopituitarism causing moderate-severe hyponatremia.

查看原文本刊更多论文

垂体神经内分泌肿瘤中有症状和无症状卒中患者临床特征的差异

目的垂体性中风是由垂体神经内分泌肿瘤（PitNET）出血和/或梗死引起的。虽然以急性临床综合征为特征，包括头痛、视力恶化和脑神经麻痹，但有一部分病例是偶然发现的“无症状”。没有资料比较有症状和无症状中风的术前特征和预后。为此，我们旨在阐明有症状和无症状垂体卒中患者临床特征的差异。方法回顾性分析2013年至2023年间出现的所有脑卒中PitNETs。比较有症状和无症状病例的术前临床、血液学和影像学特征。仅在激素免疫组化的基础上进行病理分类，并观察两组预后的差异。结果83例患者，67例有症状性中风，16例无症状性中风。头痛、呕吐和脑神经麻痹在有症状的中风患者中更为常见。有症状卒中组白细胞总数、中性粒细胞与淋巴细胞比值（NLR）显著高于无症状卒中组（p <； 0.001和0.030）。低钠血症发生率为42.2%，在急性中风中更为常见，所有中重度低钠血症均由SIADH和低皮质醇血症引起。8例患者发生与白细胞总数和NLR显著增加相关的血栓形成事件。结论有症状性和无症状性垂体卒中具有明显的临床特征。白细胞增多和NLR显著增高与症状性中风有关，也与症状性中风的血栓形成事件有关。低钠血症经常伴随垂体卒中，特别是在有症状的病例中，SIADH和垂体功能减退引起中度至重度低钠血症。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of Clinical Neuroscience 医学-临床神经学

CiteScore

4.50

自引率

0.00%

发文量

402

审稿时长

40 days

期刊介绍： This International journal, Journal of Clinical Neuroscience, publishes articles on clinical neurosurgery and neurology and the related neurosciences such as neuro-pathology, neuro-radiology, neuro-ophthalmology and neuro-physiology. The journal has a broad International perspective, and emphasises the advances occurring in Asia, the Pacific Rim region, Europe and North America. The Journal acts as a focus for publication of major clinical and laboratory research, as well as publishing solicited manuscripts on specific subjects from experts, case reports and other information of interest to clinicians working in the clinical neurosciences.