Endocrine Abstracts

Pituitary apoplexy is an uncommon, but well recognised clinical syndrome, which usually results from ischaemic or haemorrhagic necrosis of pituitary gland, which is frequently precipitated by an existing pituitary adenoma. Early diagnosis of this condition is essential as prompt management may be life and vision saving. We are highlighting a case of Pituitary apoplexy on long term Cabergoline for Prolactinoma.

Case report: A 62 year old lady presented to emergency department with history of sudden onset of severe headache after waking up in the morning. She also mentioned about multiple episode of vomiting and photophobia. Her past medical history includes stem cell transplant for Leukaemia, CKD stage 3, Macroprolactinoma which was diagnosed in 2015 and treated with Cabergoline. Her neurological examination was grossly normal apart from left sided temporal hemianopia. She underwent a CT scan of head which showed enlargement of the known pituitary adenoma which suspicion of haemorrhage within it. She was started on IV hydrocortisone. Her pituitary hormonal profile was done. Formal visual field study showed evidence of bi-temporal (L>R) hemianopia. She had a dedicated pituitary MRI which confirmed the evidence of haemorrhage within the adenoma. Her case was discussed urgently with neurosurgical team and was treated conservatively. She underwent daily visual field study which significantly improved over next few days. Her Cabergoline was continued. Her recovery was uneventful and was discharged with appropriate medical follow up with pituitary MDT.

Discussion and learning point: 1. The role of dopamine agonist’s treatment as precipitating factor is still questionable.2. Role of thorough clinical examination is always the key to aid management. In this case findings of bedside visual field test were promptly addressed.3. High index of suspicion, early management and interdisciplinary collaboration is the key to prevent serious complications.