Endocrine Abstracts

Introduction: Pituitary apoplexy is a rare endocrine emergency that can occur due to pituitary infarction or hemorrhage. There are conflicting data regarding the type of pituitary adenoma prone to apoplexy. Prolactinomas seem to have the highest risk. We report 2 cases of apoplexy of a somatotropic adenoma not medically treated

Case 1: Patient aged 45 years, with a history of chronic headaches, hospitalized in the emergency room for management of a meningeal syndrome with violent headaches associated with vomiting, a significant decrease in visual acuity, exophthalmos and ptosis of the left eye. The patient was treated with antibiotics and underwent a brain scan which returned normal. In front of the observation of a dysmorphic syndrome typical of acromegaly, she was referred to the endocrinology department where the diagnosis of acromegaly was confirmed biologically, the pituitary imaging revealed a necrotic pituitary adenoma. The evolution was marked by a recurrence of the macroadenoma 6 years later.

Case 2: A 57-year-old patient was admitted to a neurology emergency room for intense headaches that were resistant to analgesics, with decreased visual acuity and diplopia. The pituitary CT scan showed a macroadenoma of 2 x 1.6 cm with erosion of the sellar floor. The evolution is marked by the spontaneous appearance of an empty sella turcica with progressive installation of an antehypophyseal insufficiency with therapeutic normalization of GH levels under medical treatment (somatuline and cabergoline) and substitution of hormonal deficits.

Conclusion: Pituitary apoplexy is a rare complication of pituitary adenomas, it must be suspected in front of brutal headaches with ophthalmologic disorders. Its management must be multidisciplinary.