Endocrine Abstracts

Introduction: Pituitary apoplexy is an acute infarction and/or hemorrhage of the normal or tumoral pituitary gland. It is a rare mode of revelation of pituitary adenomas, and the only situation where the pituitary adenoma can be complicated by a diabetes insipidus.

Case report: Mrs Amina. Y, 54 years old, has been followed for 8 years for diabetes mellitus treated with metformin, and dyslipidemia under statins, presents in consultation for a severe polyuro-polydipsic syndrome, the urinary osmolarity was 95mOsmol/l confirming the diagnosis of diabetes insipidus. In her history, the patient reported a syndrome of intracranial hypertension with intense headaches, vomiting and visual disturbances dating back one month neglected by the patient and treated with analgesics. A cerebral MRI was performed, showing a pituitary macroadenoma in apoplexy, the visual field was affected, and the fundus was without anomalies. The workup showed a corticotropic insufficiency (cortisol level at 08h collapsed to 10 ng/l) and a thyrotropic insufficiency which were substituted. The patient was put on desmopressin with a good clinical and biological evolution. Regarding the secretory work-up, the clinical examination revealed signs in favour of an acrofacial syndrome (ring sign, change of shoe size). The IGF1 level confirmed the somatotropic character of the adenoma.

Discussion: Pituitary apoplexy is a rare but serious complication of pituitary adenoma. Considered as an emergency, Its clinical presentation associates a syndrome of intracranial hypertension, pituitary insufficiency and visual disorders that can go as far as blindness; brain imaging allows to confirm the diagnosis, and the treatment is urgent, based on hormone replacement therapy and tumor excision by Trans sphenoidal approach. Its onset is most often sudden and noisy, but more rarely, the remodeling, even massive, may be little or not symptomatic and the lesion revealed by visual disorders of progressive onset, by moderate headaches, intermittent or migraine-like, or even a secretory insufficiency as was the case in our patient in whom diabetes insipidus was the revealing element, which is the particularity of our observation.

Conclusion : The pituitary apoplexy is rare, but its gravity underlines the interest to think about it in front of any cranial symptomatology in the patients having a known pituitary adenoma, this reasoning becomes difficult, when the apoplexy is revealing, and even more difficult when the presentation is progressive and/or atypical, only the cerebral imagery, carried out in front of the slightest suspicion will make it possible to decide