2025 Poster Presentations
P215: SOCIOECONOMIC FACTORS AND HEALTH DISPARITIES IN PATIENTS WITH PITUITARY APOPLEXY.
Amanda Bingaman, BA, MS1; India Shelley, BS1; Gabriel Levis, BS1; Shiv Patil, BS2; Roger Murayi, MD1; David Bray1; James J Evans, MD1; 1Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, PA, United States; 2Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States
Introduction: Pituitary apoplexy is a rare but life-threatening event estimated to occur in around 2-12% of pituitary adenomas. Despite research looking at relevant medical comorbidities and possible risk factors, there is a lack of data on the role of socioeconomic status (SES) and other health disparities in the development of apoplexy. A better understanding of the link between social determinants of health (SDOH) and apoplexy is critical to establishing more equitable access to care.
Objective: To investigate if factors such as age, sex, race, insurance, and SES influence health outcomes seen in patients with pituitary adenoma that presented with pituitary apoplexy.
Methods: We performed a retrospective analysis of patients from a single institution who underwent surgery for pituitary adenoma that presented with pituitary apoplexy. Predictor variables analyzed included the Area Deprivation Index (ADI) and median household income, which served as proxies for SES. Additional demographic variables were assessed as well. Outcome variables included various clinical and operative outcomes, such as symptom duration, length of hospital stay, 30-day readmission rate, tumor volume, amount of residual disease, recurrence rate, and postoperative endocrine status. Variables were first assessed for normality, and linear regression was used to evaluate correlations between continuous variables (age, BMI, ADI, median household income) and outcome variables of interest. For categorical variables (sex, race, insurance status), the chi square test of independence was used.
Results: 61 patients (42M, 19F) with pituitary adenoma and radiographic evidence of pituitary apoplexy were included in this study. ADI state was directly correlated with postoperative diabetes insipidus (p=0.028) and postoperative hypocortisolism (p=0.042). There was also an inverse correlation between ADI state and presence of residual disease (p=0.05). ADI national was directly correlated with tumor volume (p=0.016) and postoperative diabetes insipidus (p=0.021), and inversely correlated with postoperative thyroid insufficiency (p=0.01). Median household income was directly correlated with vision loss for greater than 24 hours at presentation (p=0.033) and inversely correlated with tumor volume (p=0.023). There was a trend toward significance suggesting a direct correlation between median household income and postoperative thyroid insufficiency (p=0.054).
Conclusions: At our institution, lower SES, as indicated by a higher ADI, was associated with higher rates of postoperative endocrine dysfunction, including diabetes insipidus, hypocortisolism, and thyroid insufficiency. Tumor volume was directly correlated with ADI and inversely correlated with median household income, suggesting that patients with lower SES were more likely to have larger tumors. There was a trend toward patients with lower SES having less residual disease postoperatively, although this was borderline significant. Our findings help highlight potential disparities that may exist in apoplexy outcomes as a function of SES.