Endocrine Abstracts

JOINT3990

Introduction: Pituitary apoplexy is a rare but life-threatening endocrine emergency, often revealing an underlying pituitary adenoma. It results from hemorrhagic or ischemic necrosis of the pituitary gland and requires prompt diagnosis and management.

Case Presentation: We report the case of a 60-year-old man with a history of COVID-19 infection one year prior, presenting with sudden onset severe headaches, vomiting, and profound asthenia. He initially consulted the emergency department, where he was treated symptomatically and discharged. However, his symptoms worsened over the next few days, and he developed anorexia and bilateral blurred vision. Subsequently, he consulted a general practitioner, who prescribed injectable corticosteroid therapy. This treatment led to a significant improvement in his symptoms, but during the course of treatment, he developed a polyuria-polydipsia syndrome. After the corticosteroid therapy was discontinued, the patient experienced a sudden deterioration of his condition, including generalized tonic-clonic seizures. This prompted further investigations. Brain MRI revealed an intra-sellar lesion with hemorrhagic components compressing the optic chiasm, consistent with pituitary apoplexy. Hormonal assessment confirmed anterior pituitary insufficiency, including corticotropic, thyrotropic, and gonadotropic deficiencies, as well as a probable central diabetes insipidus.

Conclusion: Pituitary apoplexy is most commonly associated with macroadenomas, particularly non-functional ones. Identifying the secretion profile post-apoplexy can be challenging, as it may resolve hypersecretion caused by an adenoma. In our patient, it is important to consider potential triggering factors; a recent COVID-19 infection was suspected as a possible contributing factor. Corticotropic insufficiency is the most frequent endocrine deficit and poses a significant risk to survival. Central diabetes insipidus can be unmasked by corticosteroid therapy, which may further complicate the clinical picture. Early recognition and prompt hormonal replacement therapy are crucial for patient survival and functional recovery. While surgical decompression remains an option in severe cases, conservative management may be effective in selected patients.