pituitary apoplexy

  • Mara Carsote C.I.Parhon National Institute of Endocrinology & C.Davila University of Medicine and Pharmacy, Bucharest
  • Alexandra Ioana Trandafir C.I. Parhon National Institute of Endocrinology, Bucharest, Romania
  • Eugenia Petrova 1. C.I. Parhon National Institute of Endocrinology, Bucharest, Romania 2. C. Davila University of Medicine and Pharmacy, Bucharest, Romania
  • Adina Ghemigian 1. C.I. Parhon National Institute of Endocrinology, Bucharest, Romania 2. C. Davila University of Medicine and Pharmacy, Bucharest, Romania
  • Ana Valea I. Hatieganu University of Medicine and Pharmacy & Clinical County Hospital, Cluj-Napoca, Romania
  • Florica Sandru C. Davila University of Medicine and Pharmacy, Bucharest, Romania & Elias Emergency Hospital, Bucharest, Romania
Keywords: hypophysectomy, pituitary apoplexy, acromegaly


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.



1. Alam S, Kubihal S, Goyal A, Jyotsna VP. Spontaneous Remission of Acromegaly After Pituitary Apoplexy in a Middle-Aged Male. Ochsner J. 2021 Summer;21(2):194-199.
2. Klimko A, Capatina C. Pituitary Macroadenoma Presenting as Acromegaly and Subacute Pituitary Apoplexy: Case Report and Literature Review. Cureus. 2020 Aug 8;12(8):e9612.
3. Sanz-Sapera E, Sarria-Estrada S, Arikan F, Biagetti B. Acromegaly remission, SIADH and pituitary function recovery after macroadenoma apoplexy. Endocrinol Diabetes Metab Case Rep. 2019 Jul 15;2019(1):19-0057.
4. Zhang RC, Mu YF, Dong J, Lin XQ, Geng DQ. Complex effects of apoplexy secondary to pituitary adenoma. Rev Neurosci. 2017 Jan 1;28(1):59-64.
5. Valea A, Carsote M, Ghervan C, Georgescu C. Glycemic profile in patients with acromegaly treated with somatostatin analogue. J Med Life. 2015;8(Spec issue):79-83.
6. Banerji D, Das NK, Sharma S, Jindal Y, Jain VK, Behari S. Surgical management of acromegaly: Long term functional outcome analysis and assessment of recurrent/residual disease. Asian J Neurosurg. 2016 Jul-Sep;11(3):261-7.
7. Roerink SH, van Lindert EJ, van de Ven AC. Spontaneous remission of acromegaly and Cushing's disease following pituitary apoplexy: Two case reports.Neth J Med. 2015 Jun;73(5):242-6.
8. Puglisi V, Morini E, Biasini F, Vinciguerra L, Lanza G, Bramanti P. Neurological Presentation of Giant Pituitary Tumour Apoplexy: Case Report and Literature Review of a Rare but Life-Threatening Condition. J Clin Med. 2022 Mar 13;11(6):1581. doi: 10.3390/jcm11061581.
9. Arnold MA, Revuelta Barbero JM, Pradilla G, Wise SK.
Pituitary Gland Surgical Emergencies: The Role of Endoscopic Intervention. Otolaryngol Clin North Am. 2022 Apr;55(2):397-410.
10. Drissi Oudghiri M, Motaib I, Elamari S, Laidi S, Chadli A. Pituitary Apoplexy in Geriatric Patients: A Report of Four Cases. Cureus. 2021 Dec 10;13(12):e20318.