Endocrine Abstracts

42-year-old male with past medical history of intermittent migraines, only 1 episode this year and no known family history was referred by ophthalmology with history of sudden onset of visual loss for 4 weeks. He described having woken up with visual blurring 4 weeks ago and same degree of blurriness has remained since with no improvement or progression. He denies any headaches, nausea, vomiting or limb weakness. He suffered from covid 19 infection 1 week before presentation. On examination visual acuity was limited to hand moment, visual field assessment was limited due to reduced visual acuity, but at least bitemporal hemianopia. Rest of the neurological examination was unremarkable. Urgent MRI head was done which showed large 4.8*5.1*4.4 cm (TR*CC*AP) part cystic part solid central sellar/ suprasellar mass tenting/compressing optic nerves and optic chiasm. Solid component shows contrast enhancement and cystic component is T1 bright, protein or hemorrhage. Pituitary profile was sent which showed prolactin 26493 (normal <350), cortisol 295, FSH 0.7 (normal 1-9), LH 0.4 (normal 1-9) IGF1 74 (normal 63-201), TSH 0.03 (normal 0.4-4), testosterone 4.1 (normal 8.0-27.4). A diagnosis of Pituitary giant prolactinoma with apoplexy and hypopituitarism was made. Due to social issues patient refused to stay as an inpatient, he was offered both surgical and medical treatment with risks and benefits explained. Patient refused to go for surgery and decided to go for cabergoline 0.5 mg three times/week. He was also started on hydrocortisone and levothyroxine, with weekly ophthalmology assessment and follow up in joint neurosurgery and endocrine clinic. 8 weeks later pituitary hormone profile was repeat which showed prolactin of 20. Short synacthen test was repeated after 6 weeks which was negative. Patient himself and ophthalmology assessment noted improvement on visual field and acuity. Dose of cabergoline was reduced from 0.5 mg three times/week to once a week.

Discussion: 1. During initial discussion it was thought that patient might benefit from surgical approach as he had sudden visual loss in context of giant prolactinoma and pituitary apoplexy to achieve restoration of vision but he regained his vision back to normal just on medical therapy. 2. Any implication of covid 19 infection in causing pituitary apoplexy in patients with preexisting macroadenomas. Cases have been reported in the literature of patients presented with pituitary apoplexy after covid 19 infection.