17 E

CE Poster

presentedat:

1105-EPDhiaeddine Bellarbi DOI: 10.3252/pso.eu.17ece.2015

Endocrine tumours

ALGIERS UNIVERSITYDEPARTEMENT OF MEDICINE

Pituitary apoplexy

ENDOCRINE AND METABOLICDISEASES DEPARTMENT –BAB EL OUED HOSPITALALGIERS – ALGERIA

Bellarbi D, Azzoug S, Rabehi L, Terki B, Chentli FEndocrine and Metabolic diseases department Bab El oued Hospital – Algiers – Algeria

RESULTSApoplexy revealed an unknown adenoma in 74%.

Type of adenoma

Symptoms PredisposingFactors

Pituitary imaging

Endocrine evaluation

showed macroadenomasin al l cases.

showed at least one hormone def ic iency in 92%.

Prolact inomas48 %

Frontal and retro-orbitalHeadaches92%

Diabetes 31 % Optical chiasmainvasion in 87%

Gonadotrophdefic iency in 70%

GH secret ingadenomas22%

Visual impairment78%

Bromocript ine use in 22%

Cavernoussinuses invasion in 48%

cort icotrophdefic iency in 70%

Non funct ionningadenomas30 %

Vomit ing43 %

Antithromboticmedicat ion4.3 %

Sphenoidals inus invasionin 39%

Thyrotropicdef ic iency in 61%

Ocular Nerve palsy(diplopiaand ptosis) 40%

Pregnancy in 4.3%

Mult idirect ionalextension in 22%

Fever,meningealirr i tat ion s igns , rhinorea and epistaxis 8%

Areas of intratumoralhemorrhage were evident on MRI in 94%.

After the apoplexy episode: 40% of GH-secret ing adenomas normalized their GH-IGF-1 levels 27% of prolact inomasnormalized their prolact in levels .

S ix pat ients were treated with high dose glucocort icoids with complete neuro-ophtalmological recovery in 67%.

WHAT IS PITUITARY APOPLEXY ?Pituitary apoplexy is a rare endocrineemergency characterized by the suddenonset of severe headaches , vomitingvisual abnormalit ies and pituitarydysfunction secondary to an acutehemorrhage or infarction within apituitary adenoma.

SUBJECTS AND METHODSWe report a retrospective study from 2000to 2014 of 23 cases with pituitaryapoplexy. Their mean age was 38.7 +/- 10years, with a male to female ratio of 2:1.

0%5%

10%15%20%25%30%35%40%45%50%

Prolactinomas GH secretingadenomas

Nonfunctionning

adenomas

48%

22%

30%

TYPE OF ADENOMA

MALE65%

FEMALE35%

0%10%20%30%40%50%60%70%80%90%

100%MRI pituitary imaging

CONCLUSIONPituitary apoplexy is a rare l ife-threatening clinical syndromecaused by infarction or hemorrhage within a pituitary adenoma, oncediagnosed a multidiscipl inary team approach is mandatory in orderto improve the outcome of this condition.

DISCUSSIONIn our study apoplexy reveals generally unknown adenomas.Male sex and functioning tumours, were major risk factors.The majority of our patients had frontal and retro-orbital headachesassociated to visual impairement as symptoms.MRI pituitary imaging was the best diagnosis tool . I t detectshemorraghe in the majority of the cases. All our patients with PAhad a pituitary macroadenoma with important suprasellarextension, so large tumour size can be associated with asignificantly increased risk of PA.Diabetes, Bromocriptine, anti -thrombotic medication and pregnancycan be associated with risk of PA.An event of PA lead to pituitary insufficiency at least in onehormone in the majority of our patients requiring substitution.Our results confirm the findings of some previous studies in theliterature.