Endocrine Abstracts

Pituitary apoplexy is uncommon and the incidence is quoted to be between 5 and 16% in pre-existing pituitary adenomas. Recurrent pituitary apoplexy is rarer; we report 2 such cases.

A 22-year-old female underwent transsphenoidal resection of an expanding intrasellar lesion in 1987. She was commenced on hydrocortisone for cortisol deficiency and on subsequent follow-up, on thyroxine. She required repeated surgery in 2003 and 2005 after she presented with headaches. Imaging on both occasions confirmed haemorrhage into the pituitary lesion. She underwent stereotactic radiotherapy in 2006 and continues to be under follow-up.

A 45-year-old lady presented with sudden onset severe headache in 1998 and subsequent imaging confirmed pituitary apoplexy. She underwent transsphenoidal hypophysectomy in 2004 following a similar presentation with headaches and pituitary haemorrhage on MRI. Following dynamic testing, she was commenced on thyroxine, hydrocortisone and growth hormone replacement for hypopituitarism. Postoperative MRI showed a small amount of residual pituitary tissue. She presented with a further episode of headache in 2006 and an MRI confirmed a large lesion filled with blood in the pituitary fossa suggestive of a bleed into the residual pituitary tumour. As her visual fields were normal, she was managed conservatively. She required a further transsphenoidal surgery in 2007 due to enlargement of pituitary mass with visual field defect, followed by radiotherapy. She is under continued follow-up at the endocrine clinic.

The cause of the rare phenomenon of recurrent pituitary apoplexy is not fully understood. We hypothesize that this may be related to good vascular supply in younger patients, which makes them prone to recurrent pituitary bleeds.