Endocrine Abstracts

JOINT2631

Introduction: Pituitary apoplexy is a rare but potentially life-threatening emergency characterized by sudden haemorrhage or infarction of the pituitary gland requiring immediate medical attention. The urgency is heightened when cavernous sinus invasion is present as this significantly increases the risk of neurovascular compromise and other severe complications. Here we present a case of pituitary apoplexy complicated by cavernous sinus invasion which was successfully managed with transsphenoidal surgery. This highlights the critical importance of early surgical intervention in achieving favourable outcomes and preventing complications such as cranial nerve damage, carotid artery injury, and cavernous sinus thrombosis.

Case Presentation: A 50-year-old male presented with a 1-day history of severe headaches, vomiting, and right-sided ptosis. Initial investigations including blood tests and imaging were conducted to rule out other emergencies. Laboratory results showed IGF-1 of 113 ng/ml, prolactin of 86 ng/ml, cortisol of 41 nmol/l, TSH of 3.43 mIU/l, T4 of 5.8 µg/dl, LH of 12 IU/l, and FSH of 11 IU/L. An MRI revealed a well-circumscribed pituitary mass in the right paracentral region with invasion into the right cavernous sinus, measuring 3x2x1.5 cm. The patient’s medical history included excess alcohol intake and type 2 diabetes mellitus. The patient underwent transsphenoidal surgery without complications leading to the resolution of right-sided ptosis. Postoperatively, he is on hormone replacement therapy with levothyroxine, testosterone and hydrocortisone.

Conclusion: Pituitary apoplexy complicated with cavernous sinus invasion warrants prompt surgical decompression to prevent neurovascular compromise of important structures as well as control bleeding within the cavernous sinus. Left untreated pituitary apoplexy with cavernous sinus invasion can lead to serious complications. The literature supports that immediate surgical decompression, coupled with hormone replacement therapy is essential for optimal patient recovery and long-term prognosis.

Questions for discussion: – Should surgical intervention be done as an emergency or electively?.

– If there is recurrence, would you advocate for further surgical intervention?.

– What is an appropriate timescale for follow-up for this patient?.