Surgical versus conservative management in the treatment of pituitary apoplexy, impact on clinical and oncological outcomes: Systematic review and meta-analysis

Abstract

Abstract Purpose: To synthesize the evidence on the outcomes of visual function, hypopituitarism, ophthalmoplegia, and tumor growth/recurrence in patients with pituitary apoplexy (PA) treated either surgically or conservatively. Methods: The MEDLINE, Scopus, Web of Science, Ovid, and Cochrane databases were systematically searched. The inclusion criteria were studies of adult human beings with PA, who underwent surgery or were treated conservatively for the management of their pathology and evaluated any of the described outcomes. Studies published in English and Spanish were considered, and there was no restriction regarding the date of publication. Odds ratios were estimated for each study and treatment effects were calculated through random effects models. Results: The literature search yielded 18 studies published between 1993 and 2022, enrolling a total of 886 patients: 533 treated with surgery and 353 conservative. Patient with more severe symptoms underwent surgery. The recovery rates in visual field, endocrine function, and ophthalmoplegia, were, for overall surgery 76%, 23% and 81% respectively; early surgery 79%, 0% and 81% respectively; late surgery 73%, 0% and 70% respectively; and conservative management 79%, 23% and 90% respectively. Pooled analysis favored early surgery versus conservative management in ophthalmoplegia recovery with statistical significance OR 2.78 (CI 95% 1.09, 7.09 p = 0.03). Conclusion: Both treatment modalities may be capable to improve or completely recover deficits in the respective appropriate cases. Further reports with greater statistical power are needed comparing equivalently treatment modalities to estimate better their effects on the studied outcomes.