Endocrine Abstracts

Introduction: Pituitary apoplexy is a rare complication in 2%-12% of pituitary adenomas, due to sudden hemorrhage or infarction. Patients with signs of meningeal irritation, important visual field defects, ocular paresis, decreased unilateral or bilateral visual acuity or altered consciousness are treated by neurosurgical intervention, while patients without these signs could be managed conservatively.

Aim: To present a series of 4 cases with pituitary apoplexy managed conservatively.

Patients: 4 patients (3 men and one woman), median age 38 years at diagnosis (range 36–65) were retrospectively reviewed. There were one patient with nonfunctioning pituitary adenoma (NFA), one with acromegaly, one with macroprolactinoma and one with Cushing’s disease. There were 2 microadenomas and 2 macroadenomas (median tumor diameter 11.5 mm, range 6–41 mm). All patients but one were previously diagnosed with pituitary adenoma. No precipitating factors were identified.

Methods: FSH, LH, estradiol/testosterone, IGF1, TSH, FT4, serum cortisol and plasma ACTH, PRL were measured by chemiluminescence. Pituitary MRI and visual field assessment were performed.

Results: All patients presented with severe headaches and two patients showed ocular palsies. Signs of meningeal irritation, impaired visual field, decreased visual acuity or altered consciousness were not present in any patient. Panhypopituitarism was present in two patients. Transient aggravation of hypercortisolism was noticed in the patient with Cushing’s disease, with hyperglycemia and hypokalemia. Serum natremia was normal in all patients. Conservative approach was decided in multidisciplinary team including endocrinologist, neurosurgeon, ophthalmologist and radiologist. Steroid therapy was administered. The outcome was favorable in all patients: remission of headaches and oculomotor palsies, improvement of cortisol and GH excess in patients with Cushing’s disease and acromegaly, respectively. Tumor shrinkage was noticed in all cases.

Conclusion: In selected cases, without altered consciousness and absent or mild neuro-ophthalmic syndrome, conservative management could be an option for patients with pituitary apoplexy.