{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T22:26:02Z","timestamp":1781216762361,"version":"3.54.1"},"reference-count":41,"publisher":"MDPI AG","issue":"24","license":[{"start":{"date-parts":[[2022,12,8]],"date-time":"2022-12-08T00:00:00Z","timestamp":1670457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Pituitary apoplexy (PA) can be symptomatic, namely acute apoplexy (APA), or asymptomatic or subclinical (SPA). Objective: To describe the clinical characteristics and evolution of the patients with APA compared to SPA Patients and methods: Retrospective, longitudinal database analysis. Results: We identified 58 patients with PA, and 37 accomplished the inclusion criteria (17 men, median age 47.7 years). A total of 29 (78.4%) had APA (17 underwent surgery, and 12 were conservatively managed), and 8 (21.6%) had SPA. The presence of non-functioning pituitary adenoma (NFPA) odds ratio (OR): 29.36 (95% confidence interval (CI): 1.86\u2013462.36) and the largest size OR 1.10 (95% CI: 1.01\u20131.2) elevated the risk of having surgery. Hypopituitarism developed in 35.1% without significant differences between APA and SPA. In non-surgical patients, adenoma volume shrunk spontaneously at one year magnetic resonance imaging (MRI), without statistical differences between the conservatively treated and SPA group. Conclusions: APA is more frequent in larger NFPAs, and this subset of patients has a higher risk of surgery. Hypopituitarism is quite frequent even in patients with SPA, and, therefore, long-term follow-up is mandatory. In the non-surgical group, the pituitary tumour shrinkage is clinically relevant after one year of PA. Consequently, surgery indication in NFPA should be delayed and reassessed if patients remain asymptomatic.<\/jats:p>","DOI":"10.3390\/jcm11247288","type":"journal-article","created":{"date-parts":[[2022,12,9]],"date-time":"2022-12-09T03:23:49Z","timestamp":1670556229000},"page":"7288","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Risk Factors, Radiological and Clinical Outcomes in Subclinical and Clinical Pituitary Apoplexy"],"prefix":"10.3390","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8837-4343","authenticated-orcid":false,"given":"Betina","family":"Biagetti","sequence":"first","affiliation":[{"name":"Endocrinology Department, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"},{"name":"Diabetes and Metabolism Research Unit, Vall d\u2019Hebron Research Institute (VHIR), 08035 Barcelona, Spain"},{"name":"Universidad Aut\u00f3noma de Barcelona, 08193 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvana","family":"Sarria-Estrada","sequence":"additional","affiliation":[{"name":"Neuroradiology Section, Radiology Department, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Esteban","family":"Cordero Asanza","sequence":"additional","affiliation":[{"name":"Neurosurgery and Neurotraumatology, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9085-5314","authenticated-orcid":false,"given":"Anas","family":"Chaachou-Charradi","sequence":"additional","affiliation":[{"name":"Pathology Department, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8740-3694","authenticated-orcid":false,"given":"Yiken","family":"Ng-Wong","sequence":"additional","affiliation":[{"name":"Neuroradiology Section, Radiology Department, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2603-9072","authenticated-orcid":false,"given":"Marta","family":"Cicuendez","sequence":"additional","affiliation":[{"name":"Neurosurgery and Neurotraumatology, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Hernandez","sequence":"additional","affiliation":[{"name":"Endocrinology Department, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alba","family":"Rojano-Toimil","sequence":"additional","affiliation":[{"name":"Endocrinology Department, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pilar","family":"Costa","sequence":"additional","affiliation":[{"name":"Endocrinology Department, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Martinez-Saez","sequence":"additional","affiliation":[{"name":"Neuroradiology Section, Radiology Department, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Caster\u00e0s","sequence":"additional","affiliation":[{"name":"Endocrinology Department, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"},{"name":"Diabetes and Metabolism Research Unit, Vall d\u2019Hebron Research Institute (VHIR), 08035 Barcelona, Spain"},{"name":"Universidad Aut\u00f3noma de Barcelona, 08193 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0475-3096","authenticated-orcid":false,"given":"Rafael","family":"Sim\u00f2","sequence":"additional","affiliation":[{"name":"Endocrinology Department, Vall d\u2019Hebron University Hospital, 08035 Barcelona, Spain"},{"name":"Diabetes and Metabolism Research Unit, Vall d\u2019Hebron Research Institute (VHIR), 08035 Barcelona, Spain"},{"name":"Universidad Aut\u00f3noma de Barcelona, 08193 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,12,8]]},"reference":[{"key":"ref_1","unstructured":"Feingold, K.R., Anawalt, B., Boyce, A., Chrousos, G., de Herder, W.W., Dhatariya, K., Dungan, K., Hershman, J.M., Hofland, J., and Kalra, S. (2000). Endotext, MDText.com, Inc."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1210\/er.2015-1042","article-title":"Pituitary Apoplexy","volume":"36","author":"Briet","year":"2015","journal-title":"Endocr. Rev."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1016\/j.jocn.2009.01.003","article-title":"Manifestation, Management and Outcome of Subclinical Pituitary Adenoma Apoplexy","volume":"16","author":"Zhang","year":"2009","journal-title":"J. Clin. Neurosci."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"720","DOI":"10.1111\/cen.12349","article-title":"Impact of Subclinical Haemorrhage on the Pituitary Gland in Patients with Pituitary Adenomas","volume":"80","author":"Kinoshita","year":"2014","journal-title":"Clin. Endocrinol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1530\/eje.1.02334","article-title":"The Natural Course of Non-Functioning Pituitary Macroadenomas","volume":"156","author":"Dekkers","year":"2007","journal-title":"Eur. J. Endocrinol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"694","DOI":"10.1016\/j.jocn.2009.11.012","article-title":"Clinical Features and Surgical Outcome of Clinical and Subclinical Pituitary Apoplexy","volume":"17","author":"Liu","year":"2010","journal-title":"J. Clin. Neurosci."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1007\/s11102-020-01124-1","article-title":"Outcomes of Pituitary Apoplexy: A Comparison of Microadenomas and Macroadenomas","volume":"24","author":"Nakhleh","year":"2021","journal-title":"Pituitary"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"781","DOI":"10.1016\/j.wneu.2014.06.005","article-title":"Pituitary Apoplexy: Large Surgical Series with Grading System","volume":"82","author":"Jho","year":"2014","journal-title":"World Neurosurg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1007\/BF02112028","article-title":"Pituitary Apoplexy: Endocrine, Surgical and Oncological Emergency. Incidence, Clinical Course and Treatment with Reference to 799 Cases of Pituitary Adenomas","volume":"120","author":"Bonicki","year":"1993","journal-title":"Acta Neurochir."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2032","DOI":"10.1161\/STR.0000000000000069","article-title":"Guidelines for the Management of Spontaneous Intracerebral Hemorrhage","volume":"46","author":"Hemphill","year":"2015","journal-title":"Stroke"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1016\/j.nec.2019.06.001","article-title":"Pituitary Apoplexy","volume":"30","author":"Barkhoudarian","year":"2019","journal-title":"Neurosurg. Clin. N. Am."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1111\/j.1365-2265.2010.03913.x","article-title":"UK Guidelines for the Management of Pituitary Apoplexy","volume":"74","author":"Rajasekaran","year":"2011","journal-title":"Clin. Endocrinol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1111\/j.1365-2265.2004.02162.x","article-title":"Acute Management of Pituitary Apoplexy--Surgery or Conservative Management?","volume":"61","author":"Ayuk","year":"2004","journal-title":"Clin. Endocrinol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1310","DOI":"10.3171\/2020.9.JNS202899","article-title":"Radiological and Clinical Outcomes of Pituitary Apoplexy: Comparison of Conservative Management versus Early Surgical Intervention","volume":"135","author":"Shepard","year":"2021","journal-title":"J. Neurosurg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1812","DOI":"10.3171\/2021.12.JNS212772","article-title":"Letter to the Editor. Treatment for Pituitary Apoplexy","volume":"1","author":"Wang","year":"2022","journal-title":"J. Neurosurg."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"16","DOI":"10.4103\/2152-7806.199557","article-title":"The Impact of Surgical Timing on Visual Outcome in Pituitary Apoplexy: Literature Review and Case Illustration","volume":"8","author":"Abdulbaki","year":"2017","journal-title":"Surg. Neurol. Int."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"e70","DOI":"10.1055\/s-0040-1701217","article-title":"The Effect of Timing of Surgery in Pituitary Apoplexy on Continuously Valued Visual Acuity","volume":"82","author":"Kelly","year":"2021","journal-title":"J. Neurol. Surg. B Skull. Base"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Biagetti, B., and Sim\u00f2, R. (2022). Pituitary Apoplexy: Risk Factors and Underlying Molecular Mechanisms. Int. J. Mol. Sci., 23.","DOI":"10.3390\/ijms23158721"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"S31","DOI":"10.4103\/sja.SJA_543_18","article-title":"The STROBE Guidelines","volume":"13","author":"Cuschieri","year":"2019","journal-title":"Saudi J. Anaesth"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Knosp, E., Steiner, E., Kitz, K., and Matula, C. (1993). Pituitary Adenomas with Invasion of the Cavernous Sinus Space: A Magnetic Resonance Imaging Classification Compared with Surgical Findings. Neurosurgery, 33.","DOI":"10.1227\/00006123-199310000-00008"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"587","DOI":"10.1530\/EJE-21-0561","article-title":"Shrinkage by the Third Month Predicts Long-Term Response of Macroprolactinoma after Cabergoline","volume":"185","author":"Biagetti","year":"2021","journal-title":"Eur. J. Endocrinol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"bcr-2018-228161","DOI":"10.1136\/bcr-2018-228161","article-title":"Uncontrolled Diabetes as a Rare Presenting Cause of Pituitary Apoplexy","volume":"12","author":"Mittal","year":"2019","journal-title":"BMJ. Case Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"890","DOI":"10.4103\/ajns.ajns_217_21","article-title":"Pituitary Apoplexy Following Severe Diabetic Ketoacidosis, with Two Uncommon Complications of Supraventricular Tachycardia and Acute Limb Ischemia, in a Patient with Neglected Pituitary Adenoma and Undiagnosed Diabetes Mellitus: A Rare Clinical Association","volume":"16","author":"Pattankar","year":"2021","journal-title":"Asian J. Neurosurg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1227\/00006123-198403000-00021","article-title":"Pituitary Apoplexy: A Review","volume":"14","author":"Cardoso","year":"1984","journal-title":"Neurosurgery"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1530\/EJE-10-0651","article-title":"Pituitary Apoplexy: Re-Evaluation of Risk Factors for Bleeding into Pituitary Adenomas and Impact on Outcome","volume":"164","author":"Landau","year":"2011","journal-title":"Eur. J. Endocrinol."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Zhu, X., Wang, Y., Zhao, X., Jiang, C., Zhang, Q., Jiang, W., Wang, Y., Chen, H., Shou, X., and Zhao, Y. (2015). Incidence of Pituitary Apoplexy and Its Risk Factors in Chinese People: A Database Study of Patients with Pituitary Adenoma. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0139088"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.neuchi.2017.12.001","article-title":"Subclinical Haemorrhage in Non-Functional Adenomas","volume":"64","author":"Cebula","year":"2018","journal-title":"Neurochirurgie"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1450","DOI":"10.3171\/2014.10.JNS141204","article-title":"Management and Outcomes of Pituitary Apoplexy","volume":"122","author":"Singh","year":"2015","journal-title":"J. Neurosurg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"4238","DOI":"10.1210\/jc.2002-020309","article-title":"Vascular Endothelial Growth Factor, Its Receptor KDR\/Flk-1, and Pituitary Tumor Transforming Gene in Pituitary Tumors","volume":"87","author":"McCabe","year":"2002","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1530\/eje.0.1480203","article-title":"The Relationship between Pituitary Tumour Transforming Gene (PTTG) Expression and in Vitro Hormone and Vascular Endothelial Growth Factor (VEGF) Secretion from Human Pituitary Adenomas","volume":"148","author":"Hunter","year":"2003","journal-title":"Eur. J. Endocrinol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1444","DOI":"10.3171\/2014.10.JNS141720","article-title":"Apoplexy of Pituitary Adenomas: The Perfect Storm","volume":"122","author":"Oldfield","year":"2015","journal-title":"J. Neurosurg."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Akbari, N., Ghorbani, M., Salimi, V., Alimohammadi, A., Khamseh, M.E., Akbari, H., Nourbakhsh, M., Sheikhi, A., Taghavi, S.F., and Tavakoli-Yaraki, M. (2020). Cyclooxygenase Enzyme and PGE2 Expression in Patients with Functional and Non-Functional Pituitary Adenomas. BMC Endocr. Disord., 20.","DOI":"10.1186\/s12902-020-0515-8"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"4165","DOI":"10.3390\/ijms12064165","article-title":"TNF-\u03b1-Induced VEGF and MMP-9 Expression Promotes Hemorrhagic Transformation in Pituitary Adenomas","volume":"12","author":"Xiao","year":"2011","journal-title":"Int. J. Mol. Sci."},{"key":"ref_34","first-page":"1457","article-title":"Hypoxia Induces Hemorrhagic Transformation in Pituitary Adenomas via the HIF-1\u03b1 Signaling Pathway","volume":"26","author":"Xiao","year":"2011","journal-title":"Oncol. Rep."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1046\/j.1365-2265.2003.01598.x","article-title":"Expression of Pituitary Tumour Transforming Gene (PTTG) and Fibroblast Growth Factor-2 (FGF-2) in Human Pituitary Adenomas: Relationships to Clinical Tumour Behaviour","volume":"58","author":"McCabe","year":"2003","journal-title":"Clin. Endocrinol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"909","DOI":"10.3171\/JNS\/2008\/108\/5\/0909","article-title":"Pituitary Apoplexy: Correlation between Magnetic Resonance Imaging and Histopathological Results","volume":"108","author":"Semple","year":"2008","journal-title":"J. Neurosurg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.wneu.2019.03.133","article-title":"Vision Outcomes in Early versus Late Surgical Intervention of Pituitary Apoplexy: Meta-Analysis","volume":"127","author":"Sahyouni","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"808111","DOI":"10.3389\/fnins.2021.808111","article-title":"Ischemic Infarction of Pituitary Apoplexy: A Retrospective Study of 46 Cases From a Single Tertiary Center","volume":"15","author":"Zhu","year":"2021","journal-title":"Front. Neurosci."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"417","DOI":"10.3171\/2017.2.JNS1784","article-title":"Surgical Intervention for Pituitary Apoplexy: An Analysis of Functional Outcomes","volume":"129","author":"Rutkowski","year":"2018","journal-title":"J. Neurosurg."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1111\/cen.13075","article-title":"Pituitary Apoplexy-Bespoke Patient Management Allows Good Clinical Outcome","volume":"85","author":"Giritharan","year":"2016","journal-title":"Clin. Endocrinol."},{"key":"ref_41","unstructured":"(2022, June 12). Pituitary Apoplexy Surgical Timing & Outcomes Registry (PASTOR). Available online: https:\/\/my.clevelandclinic.org\/clinical-trials\/1039-pituitary-apoplexy-surgical-timing--outcomes-registry-pastor."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/24\/7288\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:36:26Z","timestamp":1760146586000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/24\/7288"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,8]]},"references-count":41,"journal-issue":{"issue":"24","published-online":{"date-parts":[[2022,12]]}},"alternative-id":["jcm11247288"],"URL":"https:\/\/doi.org\/10.3390\/jcm11247288","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,8]]}}}