Endocrine Abstracts

JOINT3958

Introduction: Prolactin-secreting adenomas are benign tumors caused by the proliferation of lactotroph cells in the pituitary gland. They account for 60% of pituitary adenomas. Pituitary apoplexy is a rare serious event defined as bleeding or infarction occurring within a pituitary adenoma. Here, we present the case of acute visual loss due to sudden prolactinoma apoplexy.

Case report: A 48-year-old patient with no notable medical history was admitted for retro-orbital headaches, asthenia, and weight loss. On physical examination, no oculomotor dysfunction or visual acuity loss was found. An MRI of the hypothalamic-pituitary region was performed revealing a sellar and suprasellar expansive process measuring 41.6 × 35.9 × 34.6 mm, enlarging the sella turcica and compressing the optic chiasm, bulging inferiorly into the sphenoidal sinus and extending laterally into the cavernous sinuses, encompassing both carotid arteries. Suddenly, the patient’s condition worsened, with increasing headaches, vomiting, acute total visual loss, right ptosis, and complete right ophthalmoplegia. A brain CT scan was urgently performed, revealing an 18 mm thick right temporal extradural collection and intra-lesional hemorrhage. The patient underwent emergency trans-sphenoidal surgery. The histopathological examination revealed a partially necrotic and hemorrhagic pituitary adenoma with immunohistochemical expression of prolactin. The patient has retained bilateral blindness with corticotropic, gonadotropic, and thyrotropic insufficiency.

Discussion: Pituitary apoplexy is defined as the occurrence of massive necrotic-hemorrhagic changes within a pituitary adenoma. Considered a medical emergency, its frequency remains rare (0.6% to 5% of patients undergoing surgery for pituitary pathology). Most often, pituitary apoplexy is the initial manifestation of an undiagnosed adenoma, but it can also complicate a known adenoma, as in the case of our patient. The clinical presentation of pituitary apoplexy is characterized by the sudden onset of oculomotor paralysis or visual disturbances, sometimes leading to blindness, accompanied by headaches and, occasionally, altered consciousness. Predisposing factors include pregnancy, treatment with dopamine agonists, and stimulation tests. However, no predisposing factors were identified in our patient. Urgent hormone replacement therapy and transsphenoidal tumor resection usually lead to favorable outcomes, which was not the case for our patient.

Conclusion: Pituitary apoplexy is a rare complication, often revealing a macroadenoma, that threatens both life and functional prognosis, requiring emergency management.