Endocrine Abstracts

Introduction: Pituitary apoplexy is a rare and potentially life-threatening endocrine and neurosurgical emergency, most often linked to hemorrhage or necrosis of a pituitary adenoma.

Observation: We report the case of a 45 year old patient, with a history of chronic headache, hospitalized in the emergency setting for the management of meningeal syndrome with severe headache associated with vomiting, a significant drop in visual acuity, exophthalmos and ptosis of the left eye. Patient treated with antibiotic therapy, benefited from a normal income brain scan. Faced with the finding of a typical dysmorphic syndrome of acromegaly, it is directed to the endocrinology department where the diagnosis of acromegaly is confirmed biologically, the pituitary imaging revealed a necrotic pituitary adenoma.

Discussion: Pituitary apoplexy is defined by the occurrence of a massive necrotico-hemorrhagic reorganization within a pituitary adenoma, the clinical presentation of which varies according to the extent of the hemorrhage, necrosis and edema. It associates brutal headaches, disturbances of consciousness, sometimes severe visual disturbances (this is the case of the patient), and signs of meningeal irritation with in two thirds of cases signs of endocrine deficits often corticotropic. Its prevalence is 6.2 cases/100.00 inhabitants.

Diagnosis of pituitary apoplexy should be considered in all patients with acute severe headache with or without neuro-ophthalmic signs. The initial hormonal and ophthalmological assessment is essential to allow appropriate management. Magnetic resonance imaging (MRI) is the imaging test of choice to confirm diagnosis. Surgery is indicated in the event of severe visual disturbances. The evolution is generally favorable to often depends on a transient pituitary deficit.

Conclusion: Pituitary apoplexy is a rare complication of pituitary adenomas, it must be suspected in the presence of sudden headache with ophthalmological disorders. Its management must be multidisciplinary.