Endocrine Abstracts

Introduction: Pituitary apoplexy is the rare case of panhypopituitarism. We are presenting a clinical case of pituitary apoplexy in a previously healthy 37-year-old woman.

Case report: A 37-year-old woman developed amenorrhea in August 2011. She did not visit a doctor in that time. In December 2011 she suddenly felt severe headache, symptoms of polyuria and polydipsia and temperature of 39 °C. Laboratory results revealed an increased erythrocyte sedimentation rate of 37 mm/h. One month later she felt nausea and vomiting in the morning. She has lost 6 kg of her weight for 2 last months. The cm cystic lesion 1.4×1.5×1.4 was revealed on pituitary MRI. In February 2012 clinical examination in hospital revealed dry skin, acrocyanosis and periorbital pigmentation, BMI 27.1 BP 105/75 mmHg, HR 80 bits/min. Hormone tests revealed panhypopituitarism (cortisol 50 nmol/l (190–650), ACTH – 1.1 pmol/l (0.8–11),TSH 0.9 mU/l (0.2–4.0 mU/l), fT₄ 10.0 pmol/l (11–23) and mild hyperprolactinemia (987 mU/l. FSH, LH and IGF1 were normal. Hypotonic poliuria (6 l per 24 h) was found. On repeated MRI the 1.4×0.7×1.4 cm cystic lesion with horizontal level inside it was visualized. On hormonal replacement (cortisone acetate, levothyroxine and desmopressin) she became better, but the complaints for pain in the small joints of the hand and leg swelling appeared. The patient was admitted to the hospital. After clinical evaluation anemia (Hb 72 g/l and ESR 100 mm/h) and acute renal insufficiency (creatinin level 1562 μmol/l and urea 51.4 mmol/l) were diagnosed. Anti-neutrophil cytoplasmic antibody (ANCA) were positive. A diagnosis of ANCA-associated hemorrhagic vasculitis with renal and lungs involvement and pituitary apoplexy related to haemorrhage with resultant hypopituitarism were made. Despite hormonal replacement, haemodialysis and glucocorticoid treatment the patient died from acute cardiac failure on February 2013. On autopsy – pituitary adenoma with hemorrhage revealed.

Conclusion: The following case reports illustrate the rare condition – pituitary apoplexy, with was a first sign of hemorrhagic vasculitis.