Pituitary apoplexy is a rare endocrine and neurosurgical emergency. It corresponds to the occurrence of an hemorrhage or infarction in the pituitary gland, or most often within a pituitary adenoma. The usual presentation associates sudden headaches, visual disturbances, altered consciousness and endocrine disorders wich are dominated by corticotropic insufficiency. We present two cases of pituitary apoplexy, the first one complicating an underlying pituitary adenoma, the second one revealing the adenoma, where both cases have progressed well under conservative treatment, and the surprise is that in the two cases the adenoma has totally disappeared.
70-year-old man has a nonfunctioning pituitary adenoma 25 mm, with Hypopituitarism, presented in emergency department with complaints of 1 day of fatigue, vomiting, fever 39.4°c, visual disturbances, and severe retroorbitar headache; BP was 200/70 mmhg; scored at 9 on the Glasgow scale; pituitary MRI done on D4 is compatible with apoplexy. the ophthalmological examination finds oculomotor paralysis, with reduced acuity, diplopia, ptosis in the right eye, without impairing the visual field. The evolution under conservative treatment was spectacular; marked by the recovery of consciousness after 24 h, ophthalmologic improvement from D7; total regression of the adenoma on MRI at 3 months; and even a restoration of the corticotropic function at least partial;an insulin hypoglycemia test could not be done due to age and unbalanced diabetes.
33-year-old female, without a known pitutary lesion, presented to the emergency department in april 2019 with sudden onset of severe headache without other features. she had history of generalized weakness, cycle disorders for the last 2 years; headaches and infertility for the last year.Ophthalmic evaluation revealed bitemporal upper quadrantanopia, normal acuity and no papilledema. CT of head on day 3 and MR imaging on day 4 confirm the apoplexy of a pituitary adenoma. the hormonal exploration found an corticotropic insufficiency, with low prolactin, as well as central diabetes insipidus. The clinical outcome was favorable under conservative treatment; in MRI of control there is no adenoma.
The neurosurgical approach should be favored in the event of impaired consciousness or visual disturbances, worsening or not relying at corticosteroid therapy which must be started in all cases. The apoplexy can be a form of spontaneous healing of adenomas; although monitoring remains necessary.
22 May 2021 - 26 May 2021