{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T02:49:22Z","timestamp":1790304562635,"version":"4.1.0"},"reference-count":109,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Pituitary apoplexy (PA) is a rare but potentially life-threatening endocrine emergency caused by sudden hemorrhage or infarction usually within a pituitary tumor. Clinical presentation is highly variable, ranging from isolated headache to severe visual loss or altered consciousness. Prompt recognition, multidisciplinary evaluation, and timely management are essential to improve outcomes.<\/jats:p>\n                  <jats:p>Recent prospective and real-world studies have challenged the traditional view that urgent surgery is always required. Conservative management has been proposed to be a safe and effective option, although comparisons with the outcomes after surgical intervention are limited by differences in the severity of the clinical picture at presentation of the PA. Clinical decisions remain complex and must consider tumor size, symptom progression, radiological features, and individual comorbidities. The Pituitary Apoplexy Score helps guide management but has limitations, as it does not capture key variables such as persistent headache or evolving visual symptoms. Immediate management focuses on hemodynamic stabilization, stress-dose glucocorticoid administration, and neuro-ophthalmological monitoring. Surgical decompression should be considered in patients with progressive visual deterioration or altered consciousness. Follow-up must include hormonal reassessment, ophthalmological evaluation, and imaging surveillance. Although rare, recurrence of PA and tumor regrowth may occur, requiring long-term monitoring.<\/jats:p>\n                  <jats:p>This review provides an updated and pragmatic approach for the diagnosis, acute care, and long-term follow-up of PA, summarizing current evidence and highlighting ongoing controversies, including surgical timing and predictors of conservative treatment failure.<\/jats:p>","DOI":"10.1093\/ejendo\/lvag034","type":"journal-article","created":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T12:46:29Z","timestamp":1770986789000},"page":"R49-R66","source":"Crossref","is-referenced-by-count":2,"title":["Management of endocrine disease: update on the management of pituitary apoplexy"],"prefix":"10.1093","volume":"194","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8837-4343","authenticated-orcid":false,"given":"Betina","family":"Biagetti","sequence":"first","affiliation":[{"name":"Department of Endocrinology and Nutrition, Department of Medicine, Hospital Universitario Vall de Hebr\u00f3n and Vall d\u2032Hebron Research Institute (VHIR), Autonomous University of Barcelona, Reference Networks (ERN) , Pg. de la Vall d'Hebron, 119, Horta-Guinard\u00f3, Barcelona 08035 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4959-5725","authenticated-orcid":false,"given":"Pedro","family":"Marques","sequence":"additional","affiliation":[{"name":"Pituitary Tumor Unit, Endocrinology Department, Hospital CUF Descobertas, Lisbon, Portugal Faculdade de Medicina, Universidade Cat\u00f3lica Portuguesa , 198-018 Lisbon ,","place":["Portugal"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Georgia","family":"Ntali","sequence":"additional","affiliation":[{"name":"Department of Endocrinology \u201cD. Ikkos\u201d, Diabetes and Metabolism, European and National Expertise Centre for Rare Endocrine Diseases, European Reference Network, Endo-ERN, Evangelismos Hospital , 10676 Athens ,","place":["Greece"]},{"name":"Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust , Birmingham B15 2GW ,","place":["United Kingdom"]},{"name":"Department of Metabolism and Systems Science, School of Medical Sciences, University of Birmingham , Birmingham B15 2GW ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5658-2335","authenticated-orcid":false,"given":"Georgios","family":"Tsermoulas","sequence":"additional","affiliation":[{"name":"Department of Metabolism and Systems Science, School of Medical Sciences, University of Birmingham , Birmingham B15 2GW ,","place":["United Kingdom"]},{"name":"Department of Neurosurgery, University Hospitals Birmingham NHS Foundation Trust , Birmingham B15 2GW ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4696-0643","authenticated-orcid":false,"given":"Niki","family":"Karavitaki","sequence":"additional","affiliation":[{"name":"Department of Endocrinology, University Hospitals Birmingham NHS Foundation Trust , Birmingham B15 2GW ,","place":["United Kingdom"]},{"name":"Department of Metabolism and Systems Science, School of Medical Sciences, University of Birmingham , Birmingham B15 2GW ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvana","family":"Sarria-Estrada","sequence":"additional","affiliation":[{"name":"Neuroradiology Section, Radiology Department, Vall D'Hebron University Hospital, Vall D'Hebron Barcelona Hospital Campus , Barcelona 08035 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0519-0072","authenticated-orcid":false,"given":"Marta","family":"Araujo-Castro","sequence":"additional","affiliation":[{"name":"Department of Endocrinology and Nutrition, Hospital Universitario Ram\u00f3n y Cajal , & Instituto de Investigaci\u00f3n Ram\u00f3n y Cajal (IRYCIS), Colmenar Viejo Street km 9., Madrid 28034 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,2,16]]},"reference":[{"issue":"5","key":"2026030205413322700_lvag034-B1","doi-asserted-by":"publisher","first-page":"421","DOI":"10.3171\/jns.1950.7.5.0421","article-title":"Acute degenerative changes in adenomas of the pituitary body\u2013with special reference to pituitary apoplexy","volume":"7","author":"Brougham","year":"1950","journal-title":"J 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