Endocrine Abstracts

Background: Pituitary apoplexy is a rare endocrine emergency caused by haemorrhage or infarction of a pituitary adenoma. It typically presents with sudden headache, visual changes, and cranial nerve (CN) deficits. We report a case of a young male with a gonadotroph pituitary neuroendocrine tumor (PitNET) presenting with apoplexy and requiring serial neurological assessment and urgent multidisciplinary management.

Clinical Case: A 24-year-old male presented with sudden severe headache, vomiting, and diplopia. Examination revealed left eye exotropia with nystagmus and an isolated right CN VI palsy; visual fields were grossly intact. Non-contrast CT demonstrated a 42mm sellar mass. Over the following 72 hs, he developed right ptosis with mydriasis and near-complete ophthalmoplegia except for downward gaze, indicating additional CN III and IV involvement. Pituitary MRI confirmed an irregular 3cm sellar mass with heterogenous contrast enhancement and suprasellar extension exerting mass effect on the optic chiasm. Laboratory assessment showed low random cortisol (128 nmol/l), low testosterone (3.6 nmol/l; normal 8.4–27.4), and normal prolactin (64 mIU/l; normal 56–278). He was started on intravenous hydrocortisone and transferred to tertiary care centre for urgent transsphenoidal surgery. Postoperatively, he developed transient diabetes insipidus, managed with desmopressin. CN III and IV function improved substantially, with resolution of ptosis and partial recovery of eye movements, while CN VI palsy persisted. Histopathology confirmed a gonadotroph PitNET with extensive haemorrhagic necrosis. Follow-up shows that he has sufficient cortisol reserve, but has growth hormone deficiency. Testosterone was 8.2mmmol/l.

Conclusion: This case illustrates several clinically important features of pituitary apoplexy relevant to both district general and tertiary endocrine practice. Cranial nerve deficits may evolve over several days and recover variably, requiring careful serial neurological assessment. Timely multidisciplinary intervention enabled substantial functional recovery.