Endocrine Abstracts

Introduction

Apoplexy is a rare, serious and acute complication of pituitary adenomas, revealed by tumor syndrome, visual disturbances and hormonal deficits in 60% of cases. We report a case in which the diagnosis of acromegaly was revealed by pituitary apoplexy.

Observation

45-year-old patient. The examination found a tumor syndrome made up of headaches, reduced visual acuity and vomiting which had evolved for 10 days before admission. The clinical examination reveals a rapid deterioration of the general condition associated with a dysmorphic syndrome evoking acromegaly. The hormonal assessment showed a thyrotropic, corticotropic and hyper-prolactinemia deficit with a level of IGF-1 at 486.6ng/ml (88-140) or 3.47 times the normal and on MRI a sellar process. 32 × 23 × 30mm with hemorrhagic component. The patient underwent a large adenoma excision by the transphenoidal route with simple postoperative consequences. The hormone replacement therapy was: hydrocortisone parenterally and then orally with levothyrox.

Discussion and conclusion

The revelation of acromegaly by pituitary apoplexy is exceptional. Our observation has as a particularity a favorable and rapid evolution of the pituitary apoplexy complicated by anterior pituitary insufficiency after hormonal substitution and simple postoperative consequences.