title: Incidence of Pituitary Apoplexy and Its Risk Factors in Chinese People: A Database Study of Patients with Pituitary Adenoma.
abstract: BACKGROUND
  There are few studies of the incidence and clinical characteristics of pituitary apoplexy (PA) in pituitary adenoma patients, and the findings have been inconsistent.
  
  
  OBJECTIVE
  The aim of the study was to retrospectively assess the incidence, clinical presentation, surgical management and postoperative complications of PA in pituitary adenoma patients.
  
  
  METHODS
  A database was specifically designed to collect clinical, therapeutic, prognostic and histological information about pituitary adenoma patients. Using multivariate logistic regression, odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to identify associated factors.
  
  
  RESULTS
  A total of 2021 pituitary adenoma patients were recruited. 97 (4.8%) patients had PA. The incidence of PA was 10.11% in patients with pituitary macroadenoma, and 0.36% in patients with microadenoma. Variables for the logistic regression model independently associated with PA were sex (male vs. female, OR = 2.54, 95% CI: 1.59~4.07), tumor type (negative staining vs. positive staining, OR = 2.04, 95% CI: 1.29~3.23), and tumor size (macroadenoma vs. microadenoma, OR = 26.46, 95% CI = 9.66~72.46). Headache, visual deterioration, and vomiting were the most common symptoms in patients with pituitary adenoma. Patients with and without PA had similar frequency of visual deterioration, head trauma, acromegalic appearance, galactorrhoea, cold intolerance and Cushingoid appearance, but headache, vomiting, ptosis, diplopia, fever and blindness were significantly more common in patients with PA. Pearson Chi-Square tests revealed a significant difference in surgical approach between patients with and without PA (95.88% vs. 85.57%, P = 0.01).
  
  
  CONCLUSIONS
  Our findings suggest that PA is not a rare event. Male sex, non-functioning tumor, and macroadenoma are associated with an increased risk of PA. Compared with pituitary adenoma patients without PA, patients with PA have more severe symptoms.
authors.affiliation: Department of Endocrinology & Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Pituitary Tumor Center, Shanghai, China.
authors.forename: Xiaoming
authors.initials: X
authors.lastname: Zhu
authors.affiliation: Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Pituitary Tumor Center, Shanghai, China.
authors.forename: Yongfei
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Endocrinology & Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Xuelan
authors.initials: X
authors.lastname: Zhao
authors.affiliation: Department of Endocrinology & Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Department of Endocrinology & Metabolism, Huadong Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Cuiping
authors.initials: C
authors.lastname: Jiang
authors.affiliation: Department of Endocrinology & Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Qiongyue
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: Department of Endocrinology & Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Department of Endocrinology & Metabolism, Jinshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Wenjuan
authors.initials: W
authors.lastname: Jiang
authors.affiliation: Department of Neuropathology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Pituitary Tumor Center, Shanghai, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Neuropathology, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China.
authors.forename: Haixia
authors.initials: H
authors.lastname: Chen
authors.affiliation: Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Pituitary Tumor Center, Shanghai, China.
authors.forename: Xuefei
authors.initials: X
authors.lastname: Shou
authors.affiliation: Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Pituitary Tumor Center, Shanghai, China.
authors.forename: Yao
authors.initials: Y
authors.lastname: Zhao
authors.affiliation: Department of Endocrinology & Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Pituitary Tumor Center, Shanghai, China.
authors.forename: Yiming
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Neurosurgery, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Pituitary Tumor Center, Shanghai, China.
authors.forename: Shiqi
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Endocrinology & Metabolism, Huashan Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Shanghai Pituitary Tumor Center, Shanghai, China.
authors.forename: Hongying
authors.initials: H
authors.lastname: Ye
mesh_terms: D000236:Adenoma / Q000145:classification / Q000150:complications*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044466:Asian People; D002648:Child; D002681:China / Q000453:epidemiology; D019992:Databases as Topic; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010899:Pituitary Apoplexy / Q000453:epidemiology* / Q000209:etiology* / Q000601:surgery; D010911:Pituitary Neoplasms / Q000145:classification / Q000150:complications*; D011183:Postoperative Complications / Q000209:etiology; D012307:Risk Factors; D055815:Young Adult