Endocrine Abstracts

Introduction: Pituitary apoplexy is a relatively rare clinical emergency in endocrinology. It results from hemorrhage or infarction in the pituitary gland. This clinical state is characterized headache, vomiting, visual defects, and signs of meningeal irritability.

Case: 22-years-old woman was referred to hospital because of predicted haemorrhagic or cystic pituitary adenom in magnetic resonance imaging (MRI). She was married but not a child. She had menstruel irregularity. Her clinical examination was normal except for slightly headache. Pituitary MRI was repeated. It was showed that T2-weighted images measured 12 mm in diameter reveal a nodular appearance with blood-forming blood products forming fluid levels, which was compressing the optic chiasm. Hormonal laboratory results: TSH: 1.36 mIU/ml (0.3–5.8), LH: 2.77 mIU/ml, FSH: 6.15 mIU/ml, prolactin: 45.6 ng/ml, kortizol: 8.98 mg/dl, ACTH: 16.4 pg/ml, GH: 0.05 ng/ml, IGF-1: 118.1 ng/ml. Serum glucose, creatinin, sodium, potassium, calcium, liver enzymes and hemogram were normal. The headache of the patient was getting worse during the clinical follow-up and added visual defects. Visual field test was consistent bitemporal hemianopsia. She was consultated with insistent headache and visual disturbance by neurosurgery and decided operation. During surgery, there was soft suckable grayish mass with evidence of altered blood. Histopathology revealed apoplexy-like pituitary fragments and 0.1 cm diameter predicted pituitary adenoma. Immunohistochemistry revealed positive reactivity for prolactin and negative reactivity for ACTH, TSH, GH, FSH hormones. She showed instantly headache and vision in both eyes improvement during postoperative period. Cabergolin therapy was started.

Conclusion: We present the case of a woman diagnosed pituitary apoplexy during clinical follow-up. Clinical evaluations and MRI findings was important for pituitary apoplexy diagnosis and management.