Endocrine Abstracts

Pituitary apoplexy, a rare but impactful complication of pituitary adenomas, involves sudden hemorrhage or infarction within the pituitary gland, leading to diverse clinical presentations and complications, ranging from severe headaches to panhypopituitarism. This case series explores the intersection of pituitary apoplexy and the subsequent cessation of tumor secretion in five patients with various secreting pituitary adenomas, offering unique insights into potential curative effects. In the first case, a male with a 6 mm ACTH-secreting microadenoma experienced one year of remission post-apoplexy, only to face a subsequent relapse necessitating enrollment in a cortisol receptor blocker clinical study. In the second case, the patient experienced a critical episode characterized by intense headache, vomiting, and loss of consciousness two months prior to presenting at our department. Upon examination, the patient displayed acromegaloid clinical features and presented with newly discovered diabetes type 2. However, blood tests indicated panhypopituitarism, marking a significant clinical paradox. The MRI findings further substantiated the diagnosis, revealing signs of necrosis that strongly suggested the occurrence of pituitary apoplexy. This case underscores the complexity of pituitary apoplexy’s clinical manifestations, where symptoms spanning acromegaly and panhypopituitarism coexist, necessitating a meticulous diagnostic approach for appropriate management In another case, an acromegaly patient with modest symptoms but biochemical evidence encountered pituitary apoplexy just before scheduled neurosurgery, subsequently considered cured. The final patient, diagnosed with a GH and prolactin secreting adenoma, experienced pituitary apoplexy resulting in a cure. Remarkably, in this case, a patient with a prolactin and GH-secreting macroadenoma showed GH secretion cessation post-apoplexy, managed with dopamine agonists, with a notable tumor volume reduction two weeks later. This series collectively highlights the complex and variable outcomes associated with pituitary apoplexy, emphasizing its potential curative impact on different types of secreting pituitary adenomas. The observed changes in hormonal secretion and tumor volume provide valuable insights into the dynamic nature of these adenomas post-apoplexy. If patients successfully overcome the acute phase, pituitary apoplexy may play a beneficial role in achieving a cure for hypersecretion in pituitary adenomas.