Endocrine Abstracts

Introduction: Pituitary apoplexy (PA) is a clinical emergency resulting from acute ischemia or bleeding of the pituitary gland. Complaints of patients are usuallay headache and vision problems. We tried to discuss the reasons for presentation, pituitary imaging and hormones of patients.

Patients and Methods: 10 patients (5 men and 5 women), median age 53 years at diagnosis were retrospectively reviewed. FSH, LH, estradiol/testosterone, GH, IGF1, TSH, FT4, cortisol, ACTH, PRL were measured. Pituitary MRI were performed.

Results: When we look at the reasons for the patients’ admission; headache, nausea and vision problems in 4 patients; weakness, fatigue, nausea in 3 patients; confusion in 1 patient; abdominal pain in 1 patient;polyuria, polydipsia, weight loss in 1 patient. Only one patient had a previous history of pituitary adenoma. Panhypopituitarism was present in all patients. One patient had diabetes insipidus too. Macrodenoma was detected in 6 patients (median tumor diameter 31.8 mm). 4 patients were referred to the operation. The pathology result of all of them was seen as nonfunctioning pituitary adenoma(NFA). In one other patient, the mass involved the pituitary and hypothalamus. The operation was not considered due to the general condition of that patient. This patient died in the follow-up. Another operated patient died despite post-operative replacement therapy. The other patient with PA had been operated for NFA about a month ago. The management of this patient was performed with medical therapy. One of the 4 patients with pituitary apoplexy detected on MRI presented at the 24^th week of pregnancy with severe headache that did not go away with analgesics. Her treatment was with medical therapy. No complications were observed in the follow-up and she was discharged. Another patient developed PA while receiving radiotherapy for acromegaly. The other one of these 4 patients had complaint with fatigue. The other patient developed PA after coronary bypass procedure. It was thought that this might cause lost a lot of blood during the bypass procedure. Empty sella developed in the follow-up of these patients. Management of these patients was performed with hormone replacement therapies.

Conclusion: Although PA often presents with headache, there are also different forms of presentation. Patients should always be evaluated from this point of view. PA is a condition that can develop very quickly. It can have very serious consequences. In our case series, it was observed that two patients died. Treatment consists of sellar decompression with steroid replacement and, in severe cases, transsphenoidal surgery