Surgical versus non-surgical treatment for pituitary apoplexy: a meta-analysis

INTRODUCTION Pituitary apoplexy is a rare condition caused by sudden hemorrhage or infarction of the pituitary gland. Its optimal management remains controversial in the literature. This meta-analysis was designed to compare the outcomes of surgical and conservative treatment. OBJECTIVE This study aimed to analyze the results of surgical treatment compared to non-surgical management for patients with pituitary apoplexy. MATERIALS AND METHODS A systematic review of the literature was performed on PubMed to identify articles comparing the outcome of surgical and non-surgical treatment. Studies comparing surgical and non-surgical treatment for pituitary apoplexy were included. RESULTS This meta-analysis included a total of 797 patients, with 450 treated surgically and 347 treated conservatively. Regarding recurrence (Graphic 1), no significant difference was observed between the surgical (9.5%) and conservative (13.1%) groups (RR=1.02; 95%CI 0.49–2.16). In terms of endocrine recovery (Graphic 2), the surgical group has a rate of 27.2%, while the conservative group had 17.5%, with no statistical significance (RR=1.18; 95%CI 0.76–1.85). Recovery from ocular nerve palsy (ONP) (Graphic 3) was observed in 45.4% of surgery patients and 36.9% of the conservative group, with no statistical significance (RR=1.09; 95%CI 0.86–1.39). Regarding visual acuity (VA) recovery (Graphic 4), the surgical group had a rate of 41.9%, compared to 19.1% in the conservative group, showing a statistical difference between the groups (RR=1.84; 95%CI 1.32–2.57). For the visual field (VF) recovery (Graphic 5), 45.2% of surgically treated patients and 19% of the conservative group showed improvement, with a statistical difference between the groups (RR=2.29; 95%CI 1.73–3.04). The findings of this meta-analysis suggest that surgical treatment should be recommended for pituitary apoplexy, especially for patients with visual field or acuity defects.