Endocrine Abstracts

Introduction: Pituitary apoplexy is a rare clinical syndrome related to abrupt hemorrhage and/or infarction of the pituitary gland,usually occurring in patients with pre-existing pituitary disease. it is an endocrine emergency requiring rapid diagnosis and appropriate management.

Observation: We report the observation of three patients.

Case 1: This is a 72 year old patient, without any particular pathological history, who presented abruptly a ptosis of the left eye without tumour syndrome, without sensory-motor deficit associated with asthenia worsening at the end of the day, without signs of hypersecretion of the pituitary gland. Total paralysis of the left oculomotor nerve was noted. MRI showed a bleeding pituitary macroadenoma and laterosellar macroadenoma. Blood hypophysogram showed thyreotropic and corticotropic insufficiency. The patient benefited from transphenoidal excision of the tumour. The evolution was favourable, marked by the regression of ptosis after orthoptic rehabilitation. The anatomopathological study showed a non-secreting pituitary macroadenoma.

Case 2: This is an 87 year old patient admitted for afemoral neck fracture, who presented an ante-pituitary insufficiency made of asthenia without tumor syndrome or pituitary secretion syndrome and the questioning finds a notion of intense headaches for several months. The hypophysogram showed a corticotropic and thyroidotropic deficit that we substituted and a decrease in gonadotropins (FSH, LH).MRI showed a necrotic suprasellate-extension pituitary macroadenoma.

Case 3: An 82-year-old patient was admitted with severe headache and vomiting associated with paralysis of the common oculomotor nerve, without pituitary secretion syndrome. Blood hypophysogram showed a corticotropic deficit which we substituted and a decrease in gonadotropins (FSH, LH). The MRI objectified a hemorrhagic pituitary macroadenoma in favor of a pituitary apoplexy. As surgery was contraindicated in the last two patients because of their medical issues, we opted for medical treatment.

Discussion: Pituitary apoplexy is an endocrine emergency. A rapid diagnosis and appropriate management can limit the occurrence of irreversible complications. These observations illustrate the particularities of this pathology in the elderly, the symptoms may be truncated and lead to a late diagnosis with its repercussions on management, without forgetting the particularity of the fragile and multi-systemic terrain which may contraindicate the usual surgical treatment.