Endocrine Abstracts

Pituitary infarctions are not unknown in patients with pituitary tumours. We describe here a 39-year-old lady, who presented with a history of sudden onset severe headache without any restriction of her visual fields. She had features of acromegaly with enlarged hand and feet size, progressive deepening of her voice and coarsening of facial features over the preceding year. She also had a euthyroid multinodular goitre. CT scan and MRI of the pituitary gland suggested cystic degeneration of a pituitary macroadenoma. She had elevated IGF-I and growth hormone levels which did not suppress during the course of an OGTT, confirming the diagnosis of acromegaly. She also had an impaired response during a Short Synacthen test, low oestradiol levels (56 pmol/l) and mildly elevated serum prolactin (578 nmol/l). Her free T4 was elevated 24.3 pmol/l (9–19). Her symptoms resolved gradually over next 3 months and a repeat OGTT showed lower GH values though it remained unsuppressed (vide table). She also developed features of DI diagnosed by water deprivation test. Her thyroid functions show features of primary hypothyroidism and she was started on thyroxine replacement.

Hence in this case, our lady had infarction of her pituitary macroadenoma, which resulted in partial resolution of her acromegalic state but concurrently developed hypopituitarism including diabetes insipidus.