Endocrine Abstracts

Introduction: Pituitary apoplexy is a rare endocrine emergency characterized by the sudden onset of severe headaches, vomiting, visual abnormalities and pituitary dysfunction secondary to an acute hemorrhage or infarction within a pituitary adenoma.

Subjects and methods: We report a retrospective study from 2000 to 2014 of 23 cases with pituitary apoplexy. Their mean age was 38.7±14.8 years, with a male to female ratio of 2:1.

Results: Apoplexy revealed an unknown adenoma in 74%. 48% were prolactinomas, 22% were GH-secreting adenomas and 30% were non functioning adenomas. The commonest presenting symptoms were frontal and retro-orbital headaches in 92%, visual impairment in 78%, vomiting in 43% and ocular nerves palsies mainly the third nerve palsy in 40% with diplopia and ptosis. Fever, meningeal irritation signs, rhinorrhea and epistaxis were reported in 8%. Predisposing factors were diabetes in 31%, bromocriptine use in 22%, antithrombotic medication in 4.3% and pregnancy in 4.3%. Pituitary imaging showed macroadenomas in all cases. These macroadenomas invade the optical chiasma in 87%, the cavernous sinuses in 48%, the sphenoidal sinus in 39% and have multidirectional extension in 22%. Areas of intratumoral hemorrhage were evident on MRI in 94%. Endocrine evaluation showed at least one hormone deficiency in 92%. Gonadotroph deficiency was present in 78%, corticotroph deficiency in 70% and thyrotropic deficiency in 61%. After the apoplexy episode 40% of GH-secreting adenomas normalized their GH–IGF1 levels and 27% of prolactinomas normalized their prolactin levels. Six patients were treated with high dose glucocorticoids with complete neuro-ophthalmological recovery in 67%.

Conclusion: Pituitary apoplexy is a rare life-threatening clinical syndrome caused by infarction or hemorrhage within a pituitary adenoma, once diagnosed a multidisciplinary team approach is mandatory in order to improve the outcome of this condition.