Endocrine Abstracts

Background: Pituitary apoplexy is a rare clinical syndrome manifested by rapid enlargement of a pituitary mass. When apoplexy occurs in functioning adenomas, it may result in spontaneous remission with or without associated hypopituitarism. Cases of recurrence in such patients are reported in literature.

Case description: We present a case of a 44 years old male, overweight and dyslipidemic that presented to our clinic in 2016 and was diagnosed with acromegaly after finding an insulin-like growth factor 1 (IGF1) of 1116.3 ng/ml, a nadir grown hormone (GH) after oral glucose tolerance test (OGTT) of 16.2 ng/ml, with no other hormonal abnormalities and a pituitary adenoma of 1.6 cm. Two days before transfenoidal adenomectomy, he complained of intense headache associated with dyspeptic symptoms and after further evaluation, the diagnosis of pituitary apoplexy is made. Following the episode of apoplexy and surgical intervention, his clinical labs revealed normal IGF1 with normal GH after OGTT and no hypopituitarism. The adenoma decreased to 0.8 cm cranio-caudal/0.46 cm – transverse. After 3 years of clinical and biochemical remission of the acromegaly, repeated IGF1 showed mild elevation of 260 ng/ml (N<227 ng/ml) with suppressed GH after OGTT with a two fold increase in the transvers diameter of the tumor at the computed tomography scan.

Conclusion: We presented a case of relapsed acromegaly after 3 years of remission following pituitary apoplexy, suggesting that such patients require long-term follow-up for the possibility of recurrence of active hormonal hypersecretion.