Endocrine Abstracts

JOINT2609

Pituitary apoplexy is a rare, potentially life-threatening condition caused by hemorrhage or infarction of the pituitary gland, often involving a pre-existing pituitary adenoma. Prompt diagnosis and intervention are essential to optimize patient outcomes. We conducted a retrospective review of 48 pituitary apoplexy cases diagnosed and managed at our tertiary endocrine center. The cohort was predominantly female (62.5%), with a mean age at diagnosis of 50.9 ± 17.2 years. Headache was the most frequent presenting symptom (52%), followed by amenorrhea (29%; 93% related to Sheehan syndrome). Other symptoms included visual disturbances (23%), cranial nerve palsies (21%), agalactorrhea (19%; all related to Sheehan syndrome), nausea/vomiting (15%), impaired mental status (11%), and fever (2%). A clear precipitating factor was identified in 15 patients (31%), including 14 due to postpartum hemorrhage (Sheehan syndrome) and 1 to somatostatin analog treatment. Potential associations were noted with intense emotional stress (2 patients) and warfarin therapy (1 patient). Endocrine evaluation at diagnosis revealed multiple pituitary deficits: secondary adrenal insufficiency (83%), secondary hypothyroidism (81%), hypogonadotropic hypogonadism (73%), GH/IGF-1 deficiency (44%), prolactin deficiency (35%), and diabetes insipidus (8%). Patients exhibited an average of 3.1 ± 1.5 hormonal deficiencies, with only 3 (6%) presenting unremarkable blood test Results Imaging showed macroadenomas in 52% of cases (60% with hemorrhage) with a mean tumor diameter of 21 mm; empty/partially empty sella turcica in 27%; microadenomas with hemorrhage in 4%; and Rathke’s cleft cyst with hemorrhage in 2%. Surgery was required in 12 patients (25%), mostly for macroadenomas with significant neurological/visual impairment. Pathology revealed 4 gonadotropinomas, 3 somatotropinomas, 2 corticotropinomas, 2 non-functioning adenomas, and 1 sample without identifiable pituitary tissue. Additionally, 5 patients (10%) underwent radiotherapy. Most patients (92%) required hormone replacement therapy, with 77% on levothyroxine, 77% on corticosteroids (hydrocortisone/prednisone), and 21% on testosterone. Less frequent replacements included estrogen/progesterone (10%), GH (2%), and desmopressin (2%). While pituitary apoplexy is acknowledged as a rare disease, our center has documented a significant number of cases, providing valuable insights into its clinical presentation and management. This highlights the need for increased awareness and prompt diagnosis, essential for improving outcomes in this challenging condition.