EMERGENCY HYPOPHYSECTOMY FOR PITUITARY APOPLEXY IN A PREVIOUSLY UNDIAGNOSED CASE OF ACROMEGALY

pituitary apoplexy

Abstract

Acromegaly is caused in majority of cases by a pituitary tumour, typically a macro-somatotropinoma. The disease associates a higher risk of cardio-vascular events, glucose profile anomalies, some cancers, but also local complications due to the tumours itself. Pituitary apoplexy is a very rare event which requires prompt recognition and intervention. This complication represents an emergency because of the risk of panhypopituitarism, including adrenal insufficiency, optic chiasma anomalies and cranial nerves paresis, thus the pituitary surgical approach is needed in order to improve the prognostic. The larger tumour, the presence of other co-morbidities like diabetes mellitus might increase the risk of this unusual disease. We aim to introduce an unusual case of pituitary apoplexy which started with headache on a previously asymptomatic young male adult, further on requiring hypopysectomy for the presence of somatotropinoma - related massive apoplexy. A young, previously healthy male patient presented for headache which led to the discovery of an underlying pituitary adenoma apoplexy.  In our patient’s case, clinical acromegalic features, laboratory results suggestive of central hypothyroidism and hypogonadism and adrenal evaluation which could not rule out insufficiency are notable. Imagistic and hystopathological examination diagnosed pituitary tumour apoplexy, a rare event that can explain laboratory findings such as moderately increased IGF1 with uncharacteristically normal GH levels in 24 hours GH profile. This illustrates the complex effects of pituitary tumour apoplexy. In addition, it is worth mentioning that following surgical treatment, IGF1 levels and glycaemic status normalized and no pituitary insufficiency was found at 3 months follow-up. Our patient’s case emphasizes the importance of rare pathologies such as pituitary tumour apoplexy in the differential diagnosis of severe headache in young otherwise healthy patients. Overall, the decision of neurosurgery in adenoma – related apoplexy helps the recovery of pituitary function, and even optic chiasma or cranial nerves complications.