Endocrine Abstracts

Introduction: Pituitary apoplexy is a rare clinical syndrome secondary to abrupt haemorrhage or infarction of the pituitary gland. It complicates 2-12% of pituitary tumour, most commonly in the setting of non-functioning adenomas 1. We are reporting a case on the evolving apoplexy. A 28-year-old male with sudden onset stabbing type frontal headache at night. He described this as the worst headache in his life. CT scan of head at presentation showed a 1.9 m lesion in the pituitary with no bleed. MRI Head scan showed pituitary mass of 20 mm × 7 mm x 24 mm abutting the optic chiasm. Whilst as an inpatient, he continued to have persistent frontal headaches. He was investigated for other causes of headache. He had a lumbar puncture which excluded subarachnoid haemorrhage. Baseline Pituitary function tests were normal cortisol = 661 nmol/l, prolactin = 76Miu/l and TSH was normal. Testosterone level was low at 8 nmol/l with low gonadotropins. On day 3 he developed polydipsia, polyuria and his serum sodium levels dropped from 140 mmol/l to 125 mmol/l, Urine sodium 43 mmol/l, serum osmolality 259, urine osmolality 196. He was placed on a fluid restriction of 1.5litres. On day 6^th of admission, he had another acute episode of headache similar to previous but with increased sweating and narrowing of vision, which lasted for 2-3 hours. He was found to be hypotensive, with a sodium levels of 114 mmol/l. Repeat CT scan showed a high signal in the pituitary in keeping with pituitary apoplexy. He was diagnosed with secondary adrenal insufficiency. Commenced on IV hydrocortisone and hypertonic saline with improvement of sodium levels and hypotension. Visual field assessment was normal. He was referred to the Neurosurgical team and the pituitary MDT he was managed conservatively.

Conclusions: Pituitary apoplexy is a medical emergency and requires prompt recognition and treatment.