Endocrine Abstracts

Case: An 18-years-old female patient suffering from headache, pituitary magnetic resonance imaging (MRI) revealed a lesion compatible with pituitary microadenoma; 8.5×5 mm in size, in the right lateral and extending to the midline of the pituitary gland. Cabergoline treatment was initiated in the external center with a prolactin level of 77 ng/ml and no other pituitary hormone abnormality. Unplanned pregnancy occurred in the patient who continued this treatment for about two months and the treatment was stopped by considering the size of the adenoma. One month later, when the patient is re-evaluated due to increased headache, in the cranial MRI; the size of the pituitary gland was increased and the hypo intense appearance was determined in the posterior part of the gland, which may be significant in terms of bleeding. Then one week after, the patient complained of blurred vision, nausea and dizziness, and applied to the emergency clinic. Repeated cranial MRI in the hospitalized patient was showed bilocular cystic appearance, 12×13×19 mm in size and found to have a fluid-fluid level in the pituitary gland localization, and was compatible with haemorrhage. Patient was had normal visual field and cortisol response and cabergoline treatment started again at the 17th+2 gestational week of the pregnancy and then, headache and other complaints were decreased.

Discussion: Pituitary apoplexy is a rare clinical syndrome characterized by sudden increase in pituitary gland volume due to ischemia and/or necrosis, usually associated with a pituitary adenoma. The coexistence of sudden onset clinical symptoms (headache, visual impairment, ophthalmoplegia) is a defining feature of classical pituitary apoplexy. Most cases are between 50 and 60 years of age and are more common in males and in the non-functioning macroadenomas. Pregnancy is a predisposition due to the formation of a relative ischemic environment by causing hyperplasia in the pituitary. Apoplexy has been reported after cabergoline treatment and it is mostly seen after macroadenomas and follow-up is recommended especially in macroadenomas after treatment. There are only a few reports of microadenoma related apoplexy in the literature. It can be argued that this may be related to the fading of the table and the skipping of the recognition. From this point of view, clinicians should be more careful not to skip the situations where positive results can be obtained with conservative methods like our case.