Is it necessary to operate on patients with pituitary hemorrhage?

Background Pituitary tumors are a common pathology in neurooncology. It is not uncommon that pituitary apoplexy is the first manifestation of the disease, and the choice of optimal tactic is important. Considering the presence of observations of spontaneous resorption of tumors after pituitary apoplexy, the standard approaches to this pathology require revision. Objectives . We aim to identifying factors that contribute to tumor resorption and compare conservative and surgical treatment methods. Methods. We review the results of treatment of 82 patients with pituitary apoplexy. 45 patients were surgically managed and 37 patients were managed conservatively. Results. Tumor size has a direct link with the rate of spontaneous resorption rates, along with hemorrhage type and localization. Dexamethasone plays an important role in conservative therapy, significantly improving outcome. Conservative treatment methods, when applied with the described algorithm allow for highly efficient results, comparable to urgent surgical intervention. Conclusion. Based on our results, we propose an updated algorithm for the treatment of patients with pituitary apoplexy. The application of the proposed algorithm will allow in some cases to avoid emergency surgery and obtain a comparable clinical result with lower patient risk.