Endocrine Abstracts

A 57-year-old female patient was presented to the neurologist in the ER because of her first grand mal-type seizure. Initial examination in the emergency department confirmed hyponatremia (Na 131 mmol/l) in laboratory findings, while CT scan of the brain and EEG were normal. During hospitalization, additional laboratory and imaging studies were performed. Neuroradiological examination was performed (CT scan of the brain, MRI of the brain and MRI of the pituitary gland), which confirmed the voluminous hippocampus on the left side and extremely widened sella turcica, with a septated cystic formation inside. The infundibulum was drawn to the right, the neurohypophysis was gracile, while the optic chiasm is drawn caudally. These were corresponded to the apoplexy of the pituitary gland (condition following haemorrhage in the area of the pituitary adenoma), which was accompanied by cystic degeneration. Hormonal tests were also performed and the results confirmed hypopituitarism (TSH was 0.90 mIU/l, fT3 4.4 pmol/l, fT4 5.9 pmol/l, FSH 1.0 U/l, LH< 0.1 U/l, estradiol 0 pmol/l, cortisol 157 nmol/l, prolactin 214 mU/l). An ophthalmological examination excluded visual field defects. Replacement therapy was initiated with levothyroxine at a dose of 75 mg and hydrocortisone 10 mg in the morning and 5 mg in the afternoon. During hospitalization her clinical condition improved and there was spontaneous recovery of serum sodium in the laboratory findings. An endocrinological control with new laboratory findings was recommended in 3 months and a control MRI of the pituitary gland in 6 months. The cause of the epilepsy was not found and further neurological monitoring is required.

Conclusion: Epi attack as s first presentation of pituitary macroadenoma.