Endocrine Abstracts

Pituitary apoplexy whether due to haemorrhage or infarction remains a rare endocrine diagnosis. Recent UK guidelines have emphasised the lack of published evidence in the management of this condition. We present our experience of 12 current cases (nine males, three females).

Eleven cases were managed conservatively (91.6%), one patient required urgent pituitary surgery. None of the above cases required pituitary radiotherapy.

Presenting symptoms were headache and meningism (75%) with ocular palsy and visual field defects in three (25%) of patients. Interestingly, 25% of patients presented with non-specific symptoms of fatigue and no headache. Clinical suspicion of Apoplexy was high in 58% of cases.

In terms of initial endocrine deficit, nine (75%) patients required steroid replacement ab initio (2 patients were successfully weaned-off, but two more had to be started on steroid replacement), consequently 75% continue on steroid replacement. 25% of patients required Levothyroxine from diagnosis with 58% currently on thyroid hormone replacement. One patient was hypogonadal at diagnosis and six more (58%) are currently on Testosterone. One patient developed partial Diabetes Insipidus and is on Desmopressin and three patients are on growth hormone replacement. Three patients so far are currently on no hormone replacement therapy. Two of these patients are on Dopamine agonist therapy for their macroprolactinomas. All other tumours are currently believed to be non-functional.

In all cases there was no evidence of tumour re-growth. Tumour shrinkage was on average 34.8% (tumour width) and 25.1% (tumour height) over an average of 3.4 years.

In conclusion, although the majority of cases have presented with the classical picture of sudden onset of headache and meningism, this was not universal. Endocrinologists do need to be aware that apoplexy can present with non-specific, non-classical symptoms.

A conservative management approach in certain clinical circumstances seems to provide satisfactory outcomes.