Endocrine Abstracts

JOINT1694

Introduction: Pituitary apoplexy is a rare life threatening condition. It corresponds to an acute ischemic infarction or hemorrhage of the pituitary gland. Several factors may predispose to pituitary apoplexy or contribute to its onset. These factors include endocrine stimulation tests, treatment with dopamine agonists, gonadotropin-releasing hormone therapy, pregnancy, and anticoagulation. Herein, we report the case of a patient with a pre-existing non-functional macroadenoma presenting pituitary apoplexy as a complication of prostatic enucleation.

Observation: A 78-year old man was referred to the Department of Endocrinology for a pituitary apoplexy. His past medical history included type 2 diabetes, chronic renal failure, cardiac arythmia, and chronic obstructive pulmonary disease. In 2018, the patient presented with cognitive disorders. A brain magnetic resonance imaging was performed showing an invasive pituitary macroadenoma measuring 30 × 20 mm. The diagnosis of non-functional macroadenoma with corticotropin, thyrotropin, and gonadotropin deficiencies was established. The patient was treated with hydrocortisone, levothyroxine, and enanthate of testosterone with a regular follow-up. In October 2024, the patient had a laser enucleation of the prostate in the context of benign prostatic hypertrophy. Immediately after surgery, he presented with a sudden acute headaches associated with visual disorders. Brain MRI showed pituitary apoplexy with large and necrotico-hemorrhagic intrasellar mass, invading the cavernous sinus and compressing the optic chiasm. The ophthalmological examination revealed a bilateral decreased visual acuity, normal visual field, and total ophthalmoplegia. The patient was treated with high dose of corticosteroids. The outcome was marked by the disappearance of the headaches, the improvement of the visual disorders, and the onset of polyuria secondary to antidiuretic hormone deficiency.

Discussion: To the best of our knowledge, we report the first case of pituitary apoplexy as a complication of prostatic enucleation. Few cases of pituitary apoplexy during laparoscopic surgery were reported. In these cases, pneumoperitoneum results in the elevation in intra-abdominal pressure and in the decrease in venous return. This phenomenon subsequently leads to an increase in intracranial venous pressure, which elevates capillary pressure within the pituitary tumor and predisposes it to hemorrhage. Furthermore, some anesthetic agent may precipitate infarction in pituitary adenomas.