Endocrine Abstracts

Introduction: Pituitary apoplexy (PA) is a rare incident defined by the occurrence of necrosis and/or haemorrhage of the pituitary gland. PA is a clinical syndrome characterized by the sudden onset of headache, vomiting, visual impairment and decreased consciousness in some cases. The objectives of our study are to describe its clinical features and characterize the visual impairments in a cohort of PA in the region of Sfax.

Methods: It is a retrospective study including a group of patients in the Endocrinology department of Hedi Chaker Hospital in Sfax over an 18-year period (2000–2017). The data collected was analysed by the SPSS version 20 software.

Results: This study included 44 patients (20 women vs 24 men) with a mean age of 50.04 ± 12.58 years. Fourteen patients (31.8%) had a pituitary adenoma known before the onset of apoplexy, secreting in 9 cases. Precipitating factor have been found in 14 cases (31.8%). At the time of apoplexy, an ophthalmological examination was performed in 34 patients only (77.3%). Visual loss was diagnosed in 10 patients (22.7%) who presented macroadeomas in all cases. A decrease in visual acuity was variable, ranging fromloss of some diopters (2 to 8) in 7 patients to a simple unilateral light perception in two cases and total blindness of one eye in one case. Bitemporal hemianopsiawas observed in 13 patients, and impairment of the visual field in 4 case. Papillary oedema was observed in 5 cases and a simple papillary pallor in 2 cases. Complete optic atrophy was observed in one case with a 2.5 cm macroadenoma and with compression of optic chiasm. The diagnosis of oculomotorpalsy was made in 9 cases (20.5%).Involvement of the common oculomotor nerve (III) was present in 7 cases (15.9%). Palsy of the pathetic nerve (IV) was noted in 4 cases. Palsy of theexternal oculomotor nerve (VI) was noted in both cases with total oculomotorpalsy.

Conclusion: The clinical picture of pituitary apoplexy is characterized by the sudden onset of oculomotor palsy or blindness with acute headaches and even consciousness impairment which need a fast intervention to prevent visual and life-threatening complications.