Endocrine Abstracts

A 50-year-old woman with no history of interest who was admitted in hospital for progressive headache 2 weeks of evolution refractory to treatment that was accompanied by emetic syndrome and paresthesias in face and arms. A CT scan of the skull (urgency) was performed which was normal. Neurology improves with analgesia and steroids, presenting mild drowsiness and mild hyponatremia (121 mEq/l). A cerebral MRI was performed, showing a right subacute hemorrhagic adenoma of 1 cm that protrudes into the suprasellar cisterna without compressing the optic chiasm and extending slightly to the right cavernous sinus. Subsequently it begins with severe headache and vomiting, aiming hemiparesis of predominance crural initially improving with hydrocortisone until it presents convulsive crisis with prolonged decrease of consciousness and loss of control of sphincters, with difficult handling of ions. Urinary skull CT scan is performed with images compatible with mild diffuse cerebral edema, so that it enters the ICU with low level of consciousness and agitation with anisocoria and analytically it is objectively a plasma sodium of 108 mEq/l, remaining in this service five days. Campimetry was performed by the Ophthalmology Service that was normal and consulted the Neurosurgery Service together with Endocrinology was decided conservative management, ruling out endonasal transsphenoidal decompression. No precipitating factors have been identified. Once stabilized, the patient was switched to hydrocortisone 100 mg/8 h, Hypothesis Polyuria clinic and suspicion of partial DI progressing favorably after being discharged after 44 days of treatment with hydrocortisone and replacement desmopressin. Since then and after more than three years of the onset of the picture is followed by the Endocrinology Service, discarding other hormonal deficits. At present, five years later, there is no neuro-endocrine symptomatology, with adrenal axis recovery without substitute treatment and in treatment with desmopressin 100 mg with withdrawal approach, in joint follow-up with skull MRI study and hypophysis without alterations, normal. To conclude the interest of this case based on the literature and the entity we describe as a potentially serious acute pituitary stroke with vital risk and that is resolved satisfactorily with conservative treatment minimizing sequelae and restitution ad integrum, with autoimmune and differencial diagnois without evidence of underlying causes and satisfactory evolution with conservative management.