Endocrine Abstracts

Pituitary apoplexy (PA) is a rare clinical syndrome related to abrupt hemorrhage and/or infarction of the pituitary gland, usually occurring in patients with preexisting pituitary disease. It is an endocrine emergency requiring rapid diagnosis and appropriate management. Pituitary apoplexy may lead to multiple pituitary hormone deficiencies. Without proper diagnosis and management, these can lead to the occurrence of irreversible complications, most significantly adrenal crisis due to secondary adrenal failure. Secondary adrenal insufficiency is the most common subtype of adrenal insufficiency caused by certain medications and pituitary conditions (pituitary masses, inflammation, hemorrhage or infiltration) and etc. We present a case of 77 y/o male patient who presented in our clinic in June of 2022 with the complaints of fatigue, weakness, voice changes, lethargy and weight loss. His medical history revealed a presence of pituitary macroadenoma diagnosed in 2009, without proper functional status assessment. His medications included levothyroxine 37.5 μg since 03.2022. Patient was hospitalized twice in 2021 due to low blood pressure, nausea, vomiting and syncope but no definitive diagnosis was made. Laboratory work-up confirmed secondary adrenal insufficiency, secondary hypothyroidism and secondary hypogonadism. Patient was referred to radiologist, upon MRI imaging diagnosis of Supra/endosellar neoplasia, with pituitary apoplexy and panhypopituitarism were made. Treatment with hydrocortisone was initiated, levothyroxine was discontinued temporarily and later restarted to avoid adrenal crisis. Patient’s clinical condition was significantly improved, he was referred to endocrine surgeon for further assessment. Decision was made to follow-up patient and continue medical treatment. Considering patient’s medical history, current clinical status and age, multidisciplinary team approach is recommended to tailor treatment options for individual cases.

References: 1. Gruber LM, Bancos I. Secondary Adrenal Insufficiency: Recent Updates and New Directions for Diagnosis and Management. Endocr Pract. 2022 Jan;28(1):110–117. doi: 10.1016/j.eprac.2021.09.011. Epub 2021 Oct 2. PMID: 34610473.

2. Hahner S, Ross RJ, Arlt W, Bancos I, Burger-Stritt S, Torpy DJ, Husebye ES, Quinkler M. Adrenal insufficiency. Nat Rev Dis Primers. 2021 Mar 11;7(1):19. doi: 10.1038/s41572-021-00252-7. PMID: 33707469.