Endocrine Abstracts

Background: Pituitary apoplexy is a rare but potentially life-threatening condition in which the pituitary gland undergoes infarction or haemorrhage, most commonly in the setting of an underlying tumour. We report on apoplexy of a diagnosed pituitary adenoma who presented with a sudden onset of headache, vomiting, ophthalmoplegia and vision loss. Neuroimaging revealed hemorrhagic pituitary mass. Trans-sphenoidal surgery was performed, which resulted in moderate neurological recovery.

Case presentation: A 36 years old patient presented in our emergency unit with a sudden onset of headache, vomiting, ophthalmoplegia, visual disturbance –vision loss. Medical history: Patient was diagnosed with pituitary macroadenoma since he was 31-years-old. He was not taking medication for this pathology. In the objective examination the patient was agitated but had a clear consciousness. His skin and mucous membranes were pale. There were no pathological sounds in the auscultation of the heart and lungs. There were not peripheral edema. Laboratory analysis: the most important data is the low value of cortisol - 1.00 mg/dl [2.9-17.3], his thyroid hormone levels, TSH, gonadotropins, prolactin and progesterone were within range. He had a low testosterone level 0.49 ng/ml [2.4-8.7]. CT Scan revealed a lesion with sellar and suprasellar extension with hyperdensity inside and around, measuring 42x38x47 mm, which modifies the sella turcica, suggestive of macroadenoma. The patient was hospitalized in Neurosurgery where intravenous fluids and hydrocortisone was immediately started. Trans-sphenoidal surgery was performed the next day which resulted in moderate neurological recovery.

Conclusion: Enlargement of the pituitary gland may precipitate haemorrhage. Pituitary apoplexy has a widely varied symptomatology—it should be considered as a differential diagnosis for headache or visual disturbance. Although the treatment of pituitary apoplexy is still a matter of debate with regard to surgery, the results of early sphenoidal procedure within 1 week after pituitary apoplexy are satisfactory than patients operated later.

Keywords: pituitary apoplexy, transphenoidal surgery, adenoma, infarction