Elsevier

Endocrine Practice

Volume 15, Issue 7, November–December 2009, Pages 725-731
Endocrine Practice

Case Report
Remission of Acromegaly After Pituitary Apoplexy: Case Report and Review of Literature

https://doi.org/10.4158/EP09126.CRRGet rights and content

ABSTRACT

Objective

To identify and present cases of acromegaly in which pituitary apoplexy resulted in remission of acromegaly, with normalization of insulinlike growth factor-I and growth hormone levels.

Methods

We present a case history of a personal patient and review the related literature in PubMed and Ovid MEDLINE.

Results

A 34-year-old man with classic acromegaly had spontaneous pituitary apoplexy, resulting in remission of his acromegaly and diabetes. Moreover, we identified 21 other similar cases in the literature and analyze the clinical presentations, possible apoplexy triggers, and hormonal sequelae. All these patients were “cured” of acromegaly, and 68% of them experienced other pituitary hormone insufficiencies after pituitary apoplexy, including 2 cases of panhypopituitarism.

Conclusion

Pituitary apoplexy can result in remission of acromegaly and in partial or complete anterior or posterior (or both) pituitary insufficiency. Thus, after suspected or confirmed pituitary apoplexy, pituitary hormone secretion must be reevaluated. This assessment may result in initiation of appropriate substitution therapy, a change in management of growth hormone overproduction, or both interventions. (Endocr Pract. 2009;15:725-731)

Section snippets

INTRODUCTION

Pituitary apoplexy is a rare complication of pituitary adenomas. It has been reported in 0.6% to 10% of surgically resected adenomas (1). Apoplexy is caused by hemorrhage or infarction of the pituitary gland (usually in a preexisting pituitary adenoma) and can vary from an asymptomatic event found on magnetic resonance imaging (MRI) or computed tomography (CT) to a life-threatening endocrine emergency (1). Acute swelling of the tumor can cause compression of nearby structures, resulting in the

CASE PRESENTATION

A 34-year-old man was referred to our clinic in August 2007, after his family physician noticed the large size of his hands. The patient reported classic signs and symptoms of acromegaly, including enlarged jaw and nose, widely spaced teeth, worsening sleep apnea, tightening of his gloves, an increase in shoe size from 11 (in 2000) to 14, sweaty oily skin, and skin tags. During the preceding 6 months, he had been diagnosed with new diabetes and hypertension.

Results of laboratory tests were as

REVIEW OF LITERATURE

We performed a review of the literature, searching for other case reports of remission of acromegaly after pituitary apoplexy. We searched PubMed using the keywords “acromegaly,” “apoplexy,” and “remission.” This search yielded 17 articles, 14 of which were relevant. The search was repeated on Ovid MEDLINE, and the same 17 articles were again retrieved. In addition, we found 4 other case reports that were referenced in these 17 articles, resulting in a total of 21 reported cases.

All the

DISCUSSION

Our case demonstrates that acromegaly can go into remission after pituitary apoplexy, an effect that has been documented in 21 other case reports. Apoplexy may also result in insufficient secretion of other pituitary hormones. In a 2008 review of pituitary apoplexy, Nawar et al (1) found a wide variation in the reported rates of hormonal dysfunction at the time of presentation, with adrenal insufficiency reported in 50% to 100% of cases, thyroid dysfunction in 25% to 75%, and gonadal

CONCLUSION

Pituitary apoplexy can occur in patients with GH- producing adenomas and should be considered in any patient with a known pituitary adenoma who presents with a new severe headache. In patients with acromegaly, pituitary apoplexy may result not only in normal or deficient GH production but also in pituitary insufficiency necessitating immediate treatment. After apoplexy, reevaluation of pituitary hormone secretion is necessary and may prompt changes in GH suppressive therapy and initiation of

DISCLOSURE

The authors have no multiplicity of interest to disclose.

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    Published as a Rapid Electronic Article in Press at http://www.endocrinepractice.org on June 22, 2009. DOI: 10.4158/EP09126.CRR

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