Endocrine Abstracts

29 year old African lady with a background of PCOS and type 2 diabetes, who was under the care of preconception clinic, presented to A&E with sudden onset headache associated with spontaneous closure of right eyelid. CT brain was suggestive of pituitary fossa lesion and pituitary MRI revealed pituitary necrosis. She was diagnosed with pituitary apoplexy and was commenced on appropriate hormone replacement. Examination revealed right complete third nerve palsy and reduced visual acuity in the right eye. BMI was 22.5 kg/m2 and there was no other focal neurological deficit. Blood tests revealed a random cortisol of 1548 nmol/l, free T3 was 2.3 pmol/l, free T4 was 832 pmol/l, TSH was 2.8 mIU/l and prolactin of 36 mU/l. Beta HCG was undetectable. The patient was transferred to a neurosurgical centre and had transsphenoidal surgery of the pituitary gland. Diabetes medications were discontinued on discharge. HbA1C done at 3, 6 and 12 months post the episode had levels <40 mmol/mol off diabetes medications and suggestive of remission. The patient was investigated in an endocrine clinic (3 years prior to the episode) for PCOS and had random cortisol checked as part of the work up panel. This was found to be 1,500 ng/l. She did not attend subsequent appointments to investigate this and was discharged. She was consistently seen in diabetes clinics and treatment was intensified to aid preconception with mixed insulin. Histology revealed a corticotroph adenoma, suggesting undiagnosed Cushing’s disease. The apoplexy resulted in resolution of Cushing’s disease causing diabetes remission.