Endocrine Abstracts

Pituitary apoplexy (PA) is an endocrine emergency characterized by acute, severe headache, visual disturbances, ophthalmoplegia, hypopituitarism and altered consciousness. This condition usually arises in an underlying pituitary adenoma. 27-year-old female without a known pitutary lesion presented to the emergency department in December 2015 with a 8-hour history of with sudden and severe frontal headache, fever, blurred vision, nausea, confusion at 36 weeks of gestation. The past history revealed that the patient had normal periods after puberty and no galactorrhea before pregnancy. Nothing was notable from her medical or family history; she did not smoke and was not taking any drugs.On admission her laboratory evaluation was revealed secondary hypothyroidism, and secondary adrenal insufficiency (Table 1).Non-contrast MRI demonstrated a macroadenoma, 2.2×2.1 cm in size with apoplexy and there were significant suprasellar extension and compression of the optic apparatus. The patient was admitted to the intensive care unit and put on intravenous steroids. She reported a dramatic improvement in her vision and headeche within 24 h after steroids treatment. After five days of hydrocortisone treatment L-thyroxine 25 μg/day treatment was given for secondary hypothyroidsm which dose increased gradually. She was treated conservatively and the clinical picture improved in a few days, followed by an uneventful pregnancy and delivery. Six month after delivery MRI report revealed empty sella and endocrinological investigation revealed secondary gonadal, thyroid and adrenal insufficiency (Table 1). Patient used hydrocortisone 20 mg/day and L-thyroxine 100 μg/day.

Conclusion: Pituitary apoplexy is a rare condition and it may manifest as the first presentation for the preexisting pituitary tumor.