Endocrine Abstracts

Pituitary apoplexy is a rare but potentially life-threatening condition that occurs due to sudden hemorrhage or infarction in a pre-existing pituitary adenoma. Here, we present a case study of a 20-year-old girl who presented to the emergency department (ED) with severe headache due to pituitary apoplexy. The patient had a history of one-year intermittent headache, which was diagnosed as migraine/cluster headache in previous ED visits. She was on Mirena coil and had amenorrhea for a year. On her most recent ED presentation, she complained of temporal severe headache, associated with heaviness in the neck and nausea, which had been increasing in intensity and frequency over the past month. Her blood pressure and other vitals were stable at presentation. CT head and MRI pituitary revealed a 15x20x18 mm heterogeneous intra/suprasellar lesion with fluid level on T2 sequence, mainly cystic, with no significant mass effect but contact with the optic chiasma, consistent with macro adenoma and pituitary apoplexy. The patient was managed with hydrocortisone and kept under medical admission for observation and subsequently discharged with oral hydrocortisone Repeat Pituitary hormone profile was normal except raised prolactin and repeat MRI pituitary showed appearances of the hemorrhagic pituitary macro adenoma\.. Prolactin levels had risen from 5300 mu/lat presentation to 7000 mu/lin two months and she was subsequently started on cabergoline. This case highlights the importance of considering pituitary apoplexy as a differential diagnosis in young patients presenting with severe headache who have contraceptive induced amenorrhoea. Early diagnosis and management can prevent further complications and improve patient outcomes.