Endocrine Abstracts

Introduction: Acromegaly is usually caused by pituitary macroadenoma producing excess growth hormone. Treatment options include surgery to remove the tumor, medications, and radiation therapy.

Case report: A 39-year-old woman has been referred to the endocrine clinic with suspected acromegaly in December 2019. Surgery for benign ovarian cyst, endometriosis, amenorrhoea, unsuccessful in vitro fertilisations were present in her medical history. She complained about thickening of fingers, facial bloating, dry skin and vision impairment. Laboratory examinations proved acromegaly, central hypothyroidism, hypogonadism and mild hyperprolactinaemia. ACTH and cortisol levels were in the normal range. Sella MR showed pituitary macroadenoma in size 17 x 12 x 14 mm. There was no abnormal finding detected by ophthalmological examination. After the diagnosis was established, levothyroxine was started and pituitary surgery was scheduled for March of 2020. Restrictions due to the coronavirus pandemic prevented the operation; this was postponed to an uncertain date in the future. We decided to start long-acting somatostatin analogue treatment. Before treatment could be started, something unexpected happened. In April 2020, severe headache, nausea, vomiting, weakness, hypotension occurred. Urgent MR showed substantial decrease in the size of the macroadenoma and haemorrhage in the tumor. Laboratory findings confirmed hypadrenia and decrease in growth hormone and insulin-like growth factor 1 levels. On follow-up, hypopituitarism was treated effectively with hormone replacement therapy. Growth hormone and insulin-like growth factor 1 levels were further reduced, the size of the pituitary adenoma decreased below 1 cm on repeated MR, the clinical features of acromegaly disappeared and no special treatment for acromegaly was required.

Conclusions: Pituitary apoplexy is a rare condition, occurs in 2-12 % in pituitary adenomas and in 0.05-4.8% in acromegaly. Typical symptoms are headache, vomiting, visual disturbances. Pituitary apoplexy might cause remission in acromegaly as seen in the case presented here.