{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T02:12:22Z","timestamp":1791943942486,"version":"4.3.4"},"reference-count":26,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2013,8,26]],"date-time":"2013-08-26T00:00:00Z","timestamp":1377475200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Clinical Endocrinology"],"published-print":{"date-parts":[[2014,3]]},"abstract":"<jats:title>Summary<\/jats:title><jats:sec><jats:title>Objective<\/jats:title><jats:p>To study the presentation, management and outcomes and to apply retrospectively the Pituitary Apoplexy Score (<jats:styled-content style=\"fixed-case\">PAS<\/jats:styled-content>) (United Kingdom (<jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>) guidelines for management of apoplexy) to a large, single\u2010centre series of patients with acute pituitary apoplexy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Design<\/jats:title><jats:p>Retrospective analysis of casenotes at a single neurosurgical centre in Liverpool, <jats:styled-content style=\"fixed-case\">UK<\/jats:styled-content>.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Fifty\u2010five patients [mean age, 52\u00b74\u00a0years; median duration of follow\u2010up, 7\u00a0years] were identified; 45 of 55 (81%) had nonfunctioning adenomas, four acromegaly and six prolactinomas. Commonest presenting features were acute headache (87%), diplopia (47\u00b72%) and visual field (<jats:styled-content style=\"fixed-case\">VF<\/jats:styled-content>) defects (36%). The most frequent ocular palsy involved the 3rd nerve (81%), followed by 6th nerve (34\u00b76%) and multiple palsies (19%). Twenty\u2010three patients were treated conservatively, and the rest had surgery either within 7\u00a0days of presentation or delayed elective surgery. Indications for surgery were deteriorating visual acuity and persistent field defects. Patients presenting with <jats:styled-content style=\"fixed-case\">VF<\/jats:styled-content> defects (<jats:italic>n<\/jats:italic>\u00a0=\u00a020) were more likely to undergo surgery (75%) than to be managed expectantly (25%). There was no difference in the rates of complete\/near\u2010complete resolution of <jats:styled-content style=\"fixed-case\">VF<\/jats:styled-content> deficits and cranial nerve palsies between those treated conservatively and those who underwent surgery. Endocrine outcomes were also similar. We were able to calculate the <jats:styled-content style=\"fixed-case\">PAS<\/jats:styled-content> for 46 patients: for the group treated with early surgery mean, <jats:styled-content style=\"fixed-case\">PAS<\/jats:styled-content> was 3\u00b78 and for those managed conservatively or with delayed surgery was 1\u00b78.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients without <jats:styled-content style=\"fixed-case\">VF<\/jats:styled-content> deficits or whose visual deficits are stable or improving can be managed expectantly without negative impact on outcomes. Clinical severity based on a <jats:styled-content style=\"fixed-case\">PAS<\/jats:styled-content>\u00a0\u2265\u00a04 appeared to influence management towards emergency surgical intervention.<\/jats:p><\/jats:sec>","DOI":"10.1111\/cen.12307","type":"journal-article","created":{"date-parts":[[2013,8,5]],"date-time":"2013-08-05T05:32:13Z","timestamp":1375680733000},"page":"419-424","source":"Crossref","is-referenced-by-count":119,"title":["Presentation, management and outcomes in acute pituitary apoplexy: a large single\u2010centre experience from the United Kingdom"],"prefix":"10.1111","volume":"80","author":[{"given":"S.","family":"Bujawansa","sequence":"first","affiliation":[{"name":"Department of Endocrinology &amp; Diabetes University Hospital Aintree Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S. K.","family":"Thondam","sequence":"additional","affiliation":[{"name":"Department of Endocrinology &amp; Diabetes University Hospital Aintree Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Steele","sequence":"additional","affiliation":[{"name":"Department of Endocrinology &amp; Diabetes University Hospital Aintree Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"D. J.","family":"Cuthbertson","sequence":"additional","affiliation":[{"name":"Department of Endocrinology &amp; Diabetes University Hospital Aintree Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. E.","family":"Gilkes","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery The Walton Centre for Neurology &amp; Neurosurgery Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Noonan","sequence":"additional","affiliation":[{"name":"Department of Ophthalmology University Hospital Aintree Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. W.","family":"Bleaney","sequence":"additional","affiliation":[{"name":"University of Liverpool Medical School Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I. A.","family":"MacFarlane","sequence":"additional","affiliation":[{"name":"Department of Endocrinology &amp; Diabetes University Hospital Aintree Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Javadpour","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery The Walton Centre for Neurology &amp; Neurosurgery Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C.","family":"Daousi","sequence":"additional","affiliation":[{"name":"Department of Endocrinology &amp; Diabetes University Hospital Aintree Liverpool UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,8,26]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.1177\/0885066607312992"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2010.03913.x"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2265.1999.00754.x"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2004.02162.x"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2006.02463.x"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11102-005-1050-3"},{"key":"e_1_2_7_8_1","first-page":"502","article-title":"A conservative management is preferable in milder forms of pituitary tumor apoplexy","volume":"34","author":"Leyer C.","year":"2011","journal-title":"Journal of Endocrinological Investigation"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11060-006-9148-7"},{"key":"e_1_2_7_10_1","first-page":"602","article-title":"A retrospective analysis of pituitary apoplexy","volume":"33","author":"Bills D.C.","year":"1993","journal-title":"Neurosurgery"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suronc.2007.06.001"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2011.04081.x"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1210\/jc.80.7.2190"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.72.845.172"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1530\/EJE-10-0651"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.1227\/01.neu.0000303191.57178.2a"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.71.4.542"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.2.5756.267"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1210\/jcem-71-2-323"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00701-004-0413-2"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.3340\/jkns.2010.48.3.213"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.3340\/jkns.2011.49.6.339"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1080\/02688690601046678"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2006.01.006"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2265.2011.04068.x"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.4158\/EP09126.CRR"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1507\/endocrj.52.117"}],"container-title":["Clinical Endocrinology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Fcen.12307","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cen.12307","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T23:15:05Z","timestamp":1696374905000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cen.12307"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2013,8,26]]},"references-count":26,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2014,3]]}},"alternative-id":["10.1111\/cen.12307"],"URL":"https:\/\/doi.org\/10.1111\/cen.12307","archive":["Portico"],"relation":{},"ISSN":["0300-0664","1365-2265"],"issn-type":[{"value":"0300-0664","type":"print"},{"value":"1365-2265","type":"electronic"}],"subject":[],"published":{"date-parts":[[2013,8,26]]}}}