Endocrine Abstracts

Introduction: Pituitary apoplexy is a rare endocrine disorder which can occur due to haemorrhage into pituitary gland. It is often associated with the presence of pituitary adenoma, uncommonly being the first clinical manifestation of an underlying tumour. It can cause hypopituitarism and diabetes insipidus. Pituitary adenomas are classified by their secretion properties as functional and clinically non-functioning, the latter, however, can exhibit positive immunostaining for pituitary cell types in histologic examination and are thus classified as ‘silent adenomas’.

Case study: A 37-year-old male patient was admitted to the Department of Neurosurgery with complaints of strong persistent headache with accompanying temporal visual fields narrowing. Pituitary tumour apoplexy was diagnosed after the imaging revealed a pituitary tumor 25 mm in diameter with features of haemorrhage. Preoperative assessment revealed gonadotropin deficiency with low concentrations of prolactin. After undergoing transsphenoidal resection of pituitary macroadenoma, hormonal evaluation unveiled additional deficiencies in the form of secondary adrenal and thyroid insufficiency with accompanying diabetes insipidus. At that point, the patient was transferred to the Department of Endocrinology of Medical University of Lublin for further evaluation. The replacement therapy with hydrocortisone, levothyroxine, testosterone and desmopressin was introduced, stabilizing and improving the patient’s condition. During the follow-up no restoration of pituitary secretion function in any axis was observed. Histologic examination of the tumour sample displayed a larger size than previously assumed (50 mm in the largest diameter), positive immunostaining for GH (diffuse) and PRL (sparse) allowing to classify the tumour as silent subtype 3 adenoma. Clinical and laboratory evaluation did not reveal any acromegalic features; decreased prolactin levels persisted.

Conclusions: Pituitary apoplexy and/or hypogonadrotropic hypogonadism can be the first symptom of pituitary macroadenoma. Clinically non-functioning adenomas may immunostain positively for more than one pituitary hormone determining their classification as silent subtype 3 adenomas.