Introduction: Pituitary apoplexy (PA) is a syndrome caused by acute hemorrhage or infarction of the pituitary gland, generally within a pituitary adenoma. Early diagnosis of PA and a multidisciplinary approach are essential for the timely treatment of pan-hypopituitarism and prevention of severe neurologic complications.
Observation: We report the cases of two men aged 46 and 53 years old with pituitary apoplexy. Apoplexy occurred in one patient with pre-existing pituitary macroadenoma and as a presenting form in the second case. Unilateral ptosis with severe visual acuity loss was the main clinical symptom in one patient and without visual acuity loss in the second one. Hypothalamic-pituitary MRI showed a macro-adenoma with hemorrhagic remodelling in one case and heterogeneous intrasellar processes in T1- and T2-weighted images. Necroticohaemorrhagic areas were observed in the second patient. Surgical treatment was proposed for both patients, after a multidisciplinary meeting. Only one patient underwent transsphenoidal surgery while conservative treatment was the therapeutic option chosen by the second one. The hormonal evaluation revealed an anterior pituitary insufficiency in both cases leading to an appropriate hydrocortisone and levothyroxin substitution.
Conclusion: The treatment of pituitary apoplexy remains controversial. Therefore, its management inside a pituitary referral center should be the rule. But the main issue remains about choosing the best therapeutic option: either surgery or conservative treatment.
18 May 2019 - 21 May 2019