Endocrine Abstracts

Background: Pituitary apoplexy is a neuroendocrine emergency, commonest cause is pituitary adenoma. It can occur with or without precipitating factors. Commonest precipitating factor is hypertension. Post traumatic pituitary apoplexy due to tumour infarction is not common.

Case report: 58 year old Nigerian painter presented with loss of consciousness, sudden headache, weakness in upper and lower limbs following fall from 3 meters high ladder while painting a house.

He had six months preceding history of poor vision in his right eye.

He was not hypertensive or diabetic. His social and family history was unremarkable. Also married with children.

Pulse rate was 93 bpm and blood pressure was 155/103 mmHg. He had laceration on the occipital region. His GCS was 10 (eye opening 3, verbal response 3 and motor response 4), power in all limbs was 4. Pupils were sluggishly reactive, no light perception on the right eye and 20 cm visual acuity on the left eye. Non-contrast brain CT scan showed pituitary fossa haemorrhage and haemorrhagic sellar/suprasellar mass suggestive of apoplectic pituitary macroadenoma.

On admission, he developed slurred speech and persistent hypoglycaemia. Hormonal profile showed low basal cortisol (99 nmol/L), low ACTH (0.5 pmol/L), low LH (0.9 u/L) and thyroid function test (TFT) suggestive of secondary hypothyroidism. Serum electrolytes & renal function were essentially normal. Assessment of Hypopituitarism secondary to post-traumatic pituitary apoplexy with C5 quadriparesis was made.

He was commenced on intramuscular hydrocortisone 100 mg every 6 hours. Repeat basal cortisol and RBG level were normal. Later switched to oral prednisolone 5 mg am, 2.5 mg pm and tabs Levo-thyronine 50 ug daily after discontinuation of hydrocortisone.

Further management was hampered by severe financial constraint and he was lost to follow up.

Conclusion: Pituitary apoplexy could be precipitated by head trauma with or without pituitary tumour. High index of suspicion is needed to avoid missed diagnosis.