Endocrine Abstracts

Introduction: Pituitary apoplexy is a rare acute complication in patients with functioning pituitary adenomas (including acromegaly) often followed by hypopituitarism and occasionally may show remission of symptoms after an apoplectic episode. We report this in an acromegalic patient who developed remission following pituitary apoplexy.

Case report: A 24 years old woman is diagnosed with acromegaly after presenting for a period of 6 months moderate headache, subtle increase in her shoe size, mild soft tissue swelling, secondary amenorrhea, bilateral galactorrhea, no visual disturbances. Pituitary MRI revealed a macroadenoma with suprasellar extension. Laboratory tests sustain the diagnosis: nonsupressive GH level in glucose tolerance test (23.4 –19–18.1–15.7–13.9 ng/ml), high IGF1 929 ng/ml, hyperprolactinemia 126 ng/ml but no hypopituitarism. Within 2 weeks from the diagnosis, just before her schedule for surgery that was no longer performed, she presented an episode of severe headache not associated with other neurological signs, subsequently she noticed a reduction of swelling, with progressive remission of the headache and of galactorrhea, restoring of her menses and developed preprandial hypoglycemia (up to 33 mg/dl). Pituitary MRI 2 weeks after the acute episode, revealed reduction of the macroadenoma with peripheral hemorrhage areas. GH values in GTT were suppressed <1 ng/ml, IGF1 was low 87.11 ng/ml, normal prolactin, no gonadotrope, thyreotrope and corticotrope insufficiency; same results at 3 months reassessment.

Conclusion: We conclude the results as pituitary apoplexy in a patient with GH secreting pituitary macroadenoma subsequently only with somatotrope insufficiency (explaining the hypoglycemia too). Although apoplexy may occur with apparent precipitating factors, in our case, spontaneous apoplexy due to hemorrhage was diagnosed; no precipitating factors were determined.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.